Optimal Management of Dysphagia in Patients with Inoperable Esophageal Cancer: Current Perspectives

Abstract

The majority of patients with esophageal cancer are diagnosed at an advanced, incurable stage. Palliation of symptoms, specifically dysphagia, is a crucial component to improve quality of life and optimize nutritional status. Despite multiple available treatment modalities, there is not one accepted or recommended to be the preferred treatment option. Palliative management is often decided by a multidisciplinary team considering factors including local availability, preference, patient life expectancy, and symptom severity. Systemic therapies such as chemotherapy are the most commonly used palliative modalities. Oncologists are most familiar with radiation for dysphagia palliation, especially for advanced metastatic cancer patients with good performance status. One common approach used by endoscopist is self-expandable metal stents. This is preferred for patients with short-term survival and poor functional status as it provides rapid relief of dysphagia. Cryotherapy is a relatively new endoscopic ablative modality and appears to be a promising option for dysphagia palliation, but more data is needed for wider adoption. This review summarizes the current literature on endoscopic and non-endoscopic treatment options for malignant dysphagia.

Endoscopic spray cryotherapy for dysphagia palliation in esophageal cancer: Systematic review and meta-analysis

“…Dysphagia is one of the most debilitating symptoms of advanced esophageal cancer and can often be challenging to manage [7]. Partially covered and fully covered selfexpanding metal stents are the most preferred modality for palliating symptomatic dysphagia in inoperable esophageal cancer [8].…”

“…However, the choice is often based on availability or endoscopist's preference and experience. Systemic chemotherapy can improve dysphagia, but this typically happens at a slow pace and can often be incomplete, resulting in the need for alternate intervention [7]. A Cochrane systematic review concluded that systemic therapy improves dysphagia but recommended against using chemotherapy alone in dysphagia palliation for esophageal cancer due to high incidence of recurrence and unclear impact on quality of life [26].…”

Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis

“…[1,2] Palliation of malignant dysphagia represents the most common indication for ES, as esophageal cancer is mainly diagnosed in advanced stages in the majority of patients. [3,4] Post-operative leaks, fistulas, or perforations can be treated endoscopically with ES, thus offering a minimally invasive and low-morbidity choice. Additionally, in selected cases with benign strictures ES could be an option and in patients with acute variceal bleeding and failed ligation, stent placement could offer a life-saving solution, by providing a time window for further interventions.…”

“…Apostolis Papaefthymiou MD 1 , Paraskevas Gkolfakis MD 2,3 , Kirill Basiliya PhD 1 , Daryl Ramai MD 4 , Georgios Tziatzios PhD 2 , Vinay Sehgal MD 1 , Andrea Telese MD 1 , Benjamin Norton MD 1 , Nasar Aslam MD 1 , Gavin Johnson MD 1 , Rehan Haidry PhD 1,5 This article is protected by copyright. All rights reserved.…”

“…Esophageal stenting has been a widely used approach to managing symptomatic dysphagia in benign and malignant esophageal diseases [1,2]. Palliation of malignant dysphagia represents the most common indication for esophageal stenting, as esophageal cancer is mainly diagnosed in advanced stages in the majority of patients [3,4]. Postoperative leaks, fistulas, and perforations can be treated endoscopically with stenting, thus offering a minimally invasive option with low morbidity.…”