Syn, W.-K.; Khan, I.; Parnell, A.; Skander, M.P.; Ahmed, M.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA110
Academic Journal
Introduction: Malignancies of the oesophagus or cardia are usually inoperable at presentation and the resulting dysphagia often requires endoscopic palliation. Aims: We describe a single centre experience in the synergistic use of APC and SEMS for the palliation of malignant dysphagia. Patients and Methods: Between Jan 2000 and Sept 2002, 51 consecutive patients with inoperable malignant dysphagia (31 adenocarcinoma, 19 squamous, 1 small cell) were referred for palliation. Depending on patient frailty and tumour characteristics, patients either had SEMS insertion (group 1: frail patient, Iong/schirrous tumour) or were entered into an APC programme (group 2: less frail, short/exophytic tumour) in a non-randomised fashion. In group 1, Flamingo stents or Oesophageal Wallstents II (Boston Scientific) were used. In group 2, APC (70W, Erbe) was repeated every 2-6 weeks. Results: Group 1: N = 19 (12M:7F, mean age 75.7 year). All patients were stented successfully, improvement in dysphagia occurred in 88% (mean reduction of dysphagia score = 1.5). Complications: bleeding 1, perforation 0, death 0. One patient developed dysphagia due to tumour overgrowth requiring secondary APC. Group 2: N = 32 (16M:16F, mean age 82.2 year). 20/32 were successfully palliated with repeated APC sessions (mean reduction of dysphagia score = 1.5, mean number of sessions per patient = 2.4, range 1-5). The remaining 12 either became too frail to continue with APC or dysphagia progressed despite APC- in these patients, SFMS were inserted after 1-4 sessions of APC. In 2/12 stented patients, tumour overgrowth occurred requiring further APC. There was no complication from APC. Overall, 45/51 have died (overall survival: mean 161days, median 111, range 6-977; survival not significantly different in the two groups (p = 0.1)). Conclusion: With careful patient seJection, APC and SEMS can be used in co-operation to provide effective palliation of malignant dysphagia.


Related Articles

  • Fully Covered Alimaxx Esophageal Metal Stents in the Endoscopic Treatment of Benign Esophageal Diseases. Senousy, Bahaa; Gupte, Anand; Draganov, Peter; Forsmark, Chris; Wagh, Mihir // Digestive Diseases & Sciences;Dec2010, Vol. 55 Issue 12, p3399 

    Background: Expandable esophageal stents are widely used for the palliation of dysphagia in patients with esophageal cancer and are also beginning to be used in patients with benign esophageal diseases such as refractory strictures and fistulas. There is concern regarding the increased risk of...

  • Palliative Dilation for Dysphagia in Esophageal Carcinoma. Heit, Howard A.; Johnson, Lawrence F.; Siegel, Stephen R.; Boyce Jr., H. Worth // Annals of Internal Medicine;Nov78 Part 1, Vol. 89 Issue 5, p629 

    Evaluates the palliative dilation for dysphagia in esophageal carcinoma. Information on the patients; Materials and methods; Results of the study.

  • X-ray quiz: a case of dysphagia. Patel, Prad // GP: General Practitioner;9/23/2002, p52 

    Presents the case of a patient with dysphagia. Assessment on the contraindication of an endoscopy; Emergence of a recurrent pulmonary aspiration as a complication of a pharyngeal pouch; Clinical manifestations of the disorder.

  • A functional diagnosis of dysphagia using videoendoscopy. Spiegel, Joseph R.; Selber, Jesse C.; Creed, Judith // ENT: Ear, Nose & Throat Journal;Aug1998, Vol. 77 Issue 8, p628 

    Focuses on the use of videoendoscopy in the diagnosis of dysphagia. Two principal aspects in evaluation of patients with symptoms of dysphagia; Assessment of swallowing ability; Performance of the videoendoscopic swallowing study (VESS); Results of the study.

  • EDITOR'S QUIZ: GI SNAPSHOT: A case of a "fragile" oesophagus. Anagnostopoulos, G. K.; Shonde, T.; Koye, P.; Ragunath, K. // Gut;Oct2006, Vol. 55 Issue 10, p1495 

    A quiz concerning the medical case of a 25-year-old man who underwent gastroscopy due to longstanding dysphagia is presented.

  • Endoscopy at 35,000 feet: Hand me that duct tape! Sonnenshein, Mark // Medical Economics;04/10/2000, Vol. 77 Issue 7, p235 

    Reports that the author had to perform endoscopy during a flight after an elderly passenger had swallowed a foreign object. Application of conscious sedation by way of a six-pack of bourbon shots; Construction of a makeshift endoscope; Benefits of ingenuity.

  • Esophageal Substitution. Neptune, Wilford B. // American Journal of Gastroenterology;Sep1969, Vol. 52 Issue 3, p218 

    Restoration of swallowing is accomplished effectively with colon substitution for the obstructed esophagus. In benign disease, the results are excellent. In malignant disease, it is a safe and reliable method for palliation. When indicated, resection of the malignant lesion, with or without...

  • Treatment of Esophageal Fistulas with a New Polyurethane- Covered, Self--Expanding Mesh Stent: A Prospective Study. Bethge, N.; Sommer, A.; Vakil, N. // American Journal of Gastroenterology;Dec1995, Vol. 90 Issue 12, p2143 

    Objectives: Esophagorespiratory fistulas are serious complications of malignant disease in the esophagus and are associated with rapid deterioration and death. Palliation has thus far consisted of insertion of a plastic stent to occlude the fistula opening. Insertion of these stents is...

  • Palliation of Malignant Esophageal Obstruction Due to Intrinsic and Extrinsic Lesions With Expandable Metal Stents. Bethge, Norbert; Sommer, Andrea; Vakil, Nimish // American Journal of Gastroenterology;Oct1998, Vol. 93 Issue 10, p1829 

    Objective: Metal stents have become the standard of care for esophageal stenting. The aim of this study was to determine the safety and efficacy of metal stents for the palliation of dysphagia caused by extraesophageal malignancies compressing the esophagus, compared with that caused by...


Read the Article


Sign out of this library

Other Topics