Abstract
A 77-year-old man underwent total pharyngo-laryngo-esophagectomy, radical neck lymph node dissection, reconstruction using the gastric tube through the posterior mediastinal route and anterior mediastinal tracheostomy with bipedicled upper thoracic apron flap (Grillo) for advanced cervical esophageal cancer. Seventeen years later, the patient complained of dysphagia. Upper gastrointestinal endoscopy revealed an elevated lesion in the reconstructed gastric tube and the biopsy specimen showed adenocarcinoma. A small-bore endoscope could not pass through the tumor because of generalized narrowing of the reconstructed gastric tube. Even a 0.038 inch guide wire could not pass through the tumor. Endoscopic argon plasma coagulation was repeated twice, and the endoscope could be inserted to the duodenum by necrotic deciduation of the tumor. A covered-type self-expandable metallic esophageal stent was placed under fluoroscopic guidance, which has enabled the patient to take food orally.
