TITLE

SYNERGISTIC USE OF ARGON PLASMA COAGULATION (APC) AND SELF-EXPANDING METALLIC STENTS (SEMS) FOR THE PALLIATION OF MALIGNANT DYSPHAGIA

AUTHOR(S)
Syn, W.-K.; Khan, I.; Parnell, A.; Skander, M.P.; Ahmed, M.M.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA110
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
9748043

 

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