A comparison of laser therapy, plastic stents, and expandable metal stents for palliation of malignant dysphagia in patients without a fistula

Gevers, A.M.; Macken, Elisabeth; Hiele, Martin; Rutgeerts, Paul

doi:10.1016/s0016-5107(98)70007-0

Cited by 73 publications

(53 citation statements)

References 16 publications

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“…Endoscopic laser therapy (ELT), electrocautery, metallic or plastic esophageal stent could alleviate their clinical symptoms, but metallic stent placement was much more effective [2] . Gevers et al [3] compared ELT, plastic stents and metallic stents in treatment of malignant obstruction and found that plastic stents were used less because of its high complication rate and short palliation time. ELT was the preferred choice in patients who had a short prospective survival time for its low complication rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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AIM:To evaluate the effects of self-expanding metal stents (SEMS) in patients with malignant esophageal obstruction and to analyze their prognosis and complications. METHODS:Seventy-four metallic stents were placed under fluoroscopic guidance in 66 patients with esophageal obstruction secondary to carcinoma, of whom, 6 cases were complicated by fistula. RESULTS:After seventy-two stents were successfully used in 66 cases without any severe complications (technical successful rate was 97%), the dysphagia score improved from 3.3±0.6 to 0.8±0.5 (P<0.01), and life quality improved significantly in all these patients. All fistulae were sealed immediately after coated stents were inserted in the six patients. New stents were placed in two patients: the stent migrated more than 2 cm, in one patient and the stent slipped into stomach in the other. Minor bleeding was found only in 28 patients during the operation. Reobstruction was found in 12 patients, but was successfully cured under endoscopy. The survival rate was 78%, 57% and 11% for 6 mo, 1 year and 2 years respectively. CONCLUSION:Placement of SEMS is a simple, safe, quick and efficient surgical method for treating esophageal carcinoma obstruction. It may be used mainly as a palliative treatment of esophageal obstruction secondary to carcinoma.

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Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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“…The main advantages include: conscious sedation during the procedure, stent placement in stricture segments without need of excessive dilation, its malleability adapts better to bends or curvatures in some stenosis and it is the treatment of choice in tracheo-esophageal fistulas with a success rate of more than 70% 2,6,7,9,20,29,30,31 .…”

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Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

Kamiyama

Sakai

Moura

et al. 2007

ABCD, arq. bras. cir. dig.

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BACKGROUND: Placement of self-expanding metallic esophageal stent in patients with advanced esophageal cancer offers excellent palliation of dysphagia and tracheo-esophageal fistulas. However, the safety of stent in patients undergoing radio and/or chemotherapy is controversial, in terms of the greater risk of complications in cases where these two treatments are used in conjunction. AIM: To assess the use of stent in patients with advanced cancer of the mid-thoracic esophagus, by comparing patients undergoing cytoreductive therapy with patients who have not undergone this treatment, in relation to improvement in the dysphagia, rate of complications, period of effectiveness and survival time. METHODS: Fifty seven patients were evaluated retrospectively (16 women and 41 men, with an average age 62 years) with advanced squamous cell carcinoma of the mid-thoracic esophagus who underwent placement of the Ultraflex™ self-expandable metallic coated stent, at the Gastrointestinal Endoscopy Unit of São Paulo University Medical School between October 1988 and October 2004. Out of the 57 patients, 24 patients received adjuvant cytoreductive therapy, and 33 patients were only treated with the stent placement. RESULTS: After stent placement, there was improvement in dysphagia in both groups; there were no differences in the rate of complications, such as migration, pain, fistula, obstruction and compression of the airways; the period of effectiveness was significantly higher in the group submitted to cytoreductive therapy (average 123 days compared to 63 days), as was the survival time (average of 210 days, compared with 120 days). CONCLUSIONS: Improvement in dysphagia was statistically significant in both groups, irrespective of whether the patient had undergone adjuvant cytoreductive therapy; there were no differences in the rate of complications between the two groups and both the period of effectiveness of the stent treatment and the survival time were higher in the group with adjuvant cytoreductive therapy.

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“…Neste momento a maioria dos pacientes apresenta doença localmente avançada ou metastática (5,8,10,12,17,19,23,29,31) . A sobrevida média é de 4 a 6 meses, independente da terapêutica aplicada (5,8,11,23,24) .…”

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“…A sobrevida média é de 4 a 6 meses, independente da terapêutica aplicada (5,8,11,23,24) . A sobrevida em 5 anos é de apenas 10% a 15% (5,10,31) . Uma vez que o tratamento curativo não é mais possível, o alívio da disfagia e a melhora da qualidade de vida tornam-se os objetivos principais da terapêutica.…”

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Neoplasia avançada de esôfago: diagnóstico ainda muito tardio

Thuler

Forones

Ferrari

2006

Arq. Gastroenterol.

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RESUMO -Racional -A neoplasia de esôfago está entre as 10 mais incidentes no Brasil. O diagnóstico é geralmente tardio e a sobrevida média é de 4 a 6 meses, independente da terapêutica. O alívio da disfagia e a melhora da qualidade de vida são os objetivos principais da terapêutica paliativa. Objetivo -Avaliar a qualidade de vida e a paliação da disfagia obtida com diferentes tipos de tratamento oferecidos aos pacientes com neoplasia avançada de esôfago. Pacientes e método -Avaliação prospectiva de 38 pacientes com neoplasia avançada de esôfago, com disfagia, sem possibilidade de tratamento curativo, entre setembro de 2001 a junho de 2005. Os pacientes foram alocados aleatoriamente, de acordo com a disponibilidade da terapia ou preferência do paciente ou do médico responsável, sendo 14 tratados com colocação de prótese (9 metálicas auto-expansíveis, 4 plásticas e 1 plástica auto-expansível), 4 com cirurgia paliativa, 8 com gastrostomia (7 cirúrgicas e 1 endoscópica) e 12 com sonda nasoenteral. Resultados -Houve melhora do índice médio de disfagia em 30 dias em todos os grupos, exceto no da gastrostomia. A colocação da prótese de esôfago melhorou a disfagia de forma estatisticamente signifi cante em relação às outras terapias paliativas. A qualidade de vida avaliada pela mediana do índice de Karnofsky não apresentou melhora em nenhum grupo de pacientes. O número de internações necessárias não foi diferente entre os grupos. A duração média das internações foi maior no grupo de tratamento cirúrgico (42 dias), embora sem diferença signifi cativa. Não houve diferença na sobrevida média dos pacientes, independente do tipo de tratamento. Conclusão -A paliação ideal para todos os casos não existe. O método deve ser individualizado para cada paciente. O tratamento cirúrgico paliativo é o mais oneroso, devido ao prolongado tempo médio de internação desses pacientes. Infelizmente, o diagnóstico de tumor de esôfago em nosso meio ainda é muito tardio, limitando o benefício que poderia advir dos métodos de ponta de paliação endoscópica. DESCRITORES -Neoplasias esofágicas. Assistência paliativa. Próteses e implantes.

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A comparison of laser therapy, plastic stents, and expandable metal stents for palliation of malignant dysphagia in patients without a fistula

Cited by 73 publications

References 16 publications

Clinical application of metallic stents in treatment of esophageal carcinoma

Clinical application of metallic stents in treatment of esophageal carcinoma

Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

Neoplasia avançada de esôfago: diagnóstico ainda muito tardio

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