A patient treated with chemoradiotherapy for hypopharyngeal cancer has progressive dysphagia and weight loss. Endoscopy and biopsies show no recurrence; contrast swallow shows a short, tight pharyngoesophageal stricture with a thread of contrast passing into the oesophagus. What is the best next intervention?
Once recurrent tumour is excluded, a short traversable radiation stricture is usually managed by controlled graded dilation within a multidisciplinary nutrition/swallow pathway.
A. Open pharyngolaryngectomy without attempting rehabilitation: With recurrence excluded and residual lumen present, less morbid rehabilitation should be attempted first.
B. Force a large bougie blindly through the stricture: Blind force risks perforation, mediastinitis and false passage in irradiated tissue.
C. Guidewire-assisted endoscopic dilation under direct and/or fluoroscopic control with nutritional and swallow support: A traversable short stricture is suited to controlled graded dilation; repeated sessions may be required and perforation risk must be discussed.
D. Botulinum toxin into the cricopharyngeus: A fixed fibrotic narrowing is not primarily muscle hypertonicity.
E. Reassure because negative biopsies exclude a significant cause: Benign treatment-related stenosis can cause severe malnutrition and aspiration.
If the lumen were completely obliterated, combined antegrade-retrograde rendezvous recanalisation or reconstructive surgery might be required.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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