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After endoscopic lumen restoration, St. Petersburg throat cancer survivor can swallow again

TAMPA — After treatment for advanced throat cancer saved his life but left him unable to swallow, Dan Robinson was resigned to spend the rest of his life with a feeding tube attached to his stomach.

And for 21/2 years, that's exactly what he did.

"My esophagus closed off. I couldn't get anything down," said Robinson, 54, a paramedic and firefighter with St. Petersburg Fire Rescue.

But then his wife, a nurse, discovered that doctors at Moffitt Cancer Center and the University of South Florida were having success with a procedure in which the throat is stretched over a period of months until it is wide enough to ingest food.

The procedure, called endoscopic lumen restoration, is used to treat a rare condition called aphagia, which occurs when radiation treatment and chemotherapy cause inflammation and scar tissue to form in the throat, creating an impenetrable blockage.

Robinson said he went to one local doctor, who tried but failed to break through the blockage. He also saw a Texas physician who suggested a radical surgery that would cut out and replace the blocked part of the esophagus with a transplanted section of his bowel. But Robinson wasn't interested.

He didn't know that a local physician was successfully restoring the ability to swallow in about half of patients he saw with aphagia, even years after they savored their last morsel of food.

Dr. Worth Boyce started offering the procedure in 1987. Although he retired from active medical practice in September, his colleague, Dr. David Estores, continues the work at the Joy McCann Culverhouse Center for Swallowing Disorders at USF.

There are no reliable data on the number of people who suffer a blocked throat or esophagus following cancer treatment. But over the years USF has treated 30, including 22 in the past decade. A handful of medical centers across the country treat the problem in small numbers of patients annually, but USF's program is considered a leader in the field.

"USF has the second-largest number of cases reported in the world medical literature," said Boyce, 81 . "I want people who are out there suffering to know it's available."

Robinson was told that the treatment works only if a sharp-tipped instrument can break through the blockage to create a narrow opening about the size of a strand of thin pasta. If that works, the medical team introduces increasingly wider instruments.

Boyce told Robinson it may not work at all, or it may only partially open the throat. But he said some patients were able to resume eating normally.

Robinson decided to give it a try.

A normal esophagus has an opening about the size of a quarter, or 22 millimeters. "We shoot for 17 millimeters," about the size of a nickel, Boyce said. "If you can get them there, they can swallow just about anything."

The procedure to create the opening is done under general anesthesia and requires a day or two in the hospital. The subsequent dilation procedures are done in an outpatient setting and performed under sedation similar to that used during a colonoscopy.

Patients must also undergo swallowing therapy to re-learn how to swallow and strengthen their throat muscles. Boyce said patients must be committed to sticking with the full course of treatment, which takes place every few weeks over several months.

Patients also must return periodically for outpatient dilation or stretching to maintain the opening for the rest of their lives.

"It's not magic," Boyce said. "It takes a lot of time and a lot of work, but it's gratifying. Patients want the pleasure of tasting some foods, so if you don't get them to 100 percent, they are still very grateful to be able to swallow just liquid and we are grateful that we can do it."

The first attempt to punch through the blockage and establish an opening for Robinson wasn't successful. But a few months later, Boyce tried again and it worked. It took him six months to re-learn how to swallow. "It was horrible," he said. "We started with Popsicles, then ice cream and apple sauce and everything hurt going down. It felt like swallowing ground glass."

But Robinson stuck with it, working regularly with a swallowing therapist until eventually it became easier.

Today, he must eat slowly, chew thoroughly and drink plenty of liquids with solid foods. He takes 45 minutes to eat a meal that used to take 15 minutes — which can be a challenge for a firefighter who is used to eating quickly between emergency calls.

But Robinson doesn't mind. While he is grateful for the oncologists who eradicated the cancer, Robinson is also grateful for Boyce,

"They (the oncologists) saved my life. Dr. Boyce gave me my life back," he said.

What's the food that Robinson missed the most? "Coffee," he said. "My morning cup of coffee."

Irene Maher may be reached at [email protected]

After endoscopic lumen restoration, St. Petersburg throat cancer survivor can swallow again 12/07/11 [Last modified: Thursday, December 8, 2011 3:48pm]
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