Palliation of Malignant Oesophageal Obstruction by Endoscopic Alcohol Injection

Chung, S. C. S.; Leong, Hio Teng; Choi, Chi‐Yee; Leung, Joseph; Li, A. K C

doi:10.1055/s-2007-1008966

Cited by 61 publications

(28 citation statements)

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“…Chemical injection therapy for the treatment of malignant dysphagia consist of ethanol or polidocanol injections into the tumor, leading to tumor necrosis within several days after therapy. Studies on chemical injection are limited and re-treatment is necessary at 4-5 weeks intervals [9][10][11]. In case of failure of palliative therapy or if other palliative modalities are technically not possible, nutritional support with a nasoenteric feeding tube or percutaneous endoscopic gastrostomy (PEG) should be considered, to maintain an adequate calorie intake [12].…”

Section: Palliative Treatment To Relieve Dysphagiamentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

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Section: Palliative Treatment To Relieve Dysphagiamentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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“…A low-cost alternative is injection of absolute alcohol, although experience with this is limited. 79 More sophisticated techniques that have been tried include injection of cisplatin/epinephrine gel into the tumor, argon plasma coagulation, and brachytherapy with the insertion of a radioactive source adjacent to the tumor. [80][81][82] More recently, photodynamic therapy has been used (discussed above).…”

Section: Palliative Treatmentmentioning

confidence: 99%

Treatment of squamous cell and adenocarcinoma of the esophagus

Jankowski¹

2012

GICTT

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Esophageal cancer is the sixth commonest cause of cancer death worldwide. It predominantly occurs in two histological types, ie, squamous cell carcinoma and adenocarcinoma, each with its own distinct geographical distribution and natural history. The incidence of esophageal adenocarcinoma is rising, as is that of its precursor lesion, Barrett's esophagus, which consists of metaplastic change in the squamous mucosa of the esophagus in response to damage by gastroesophageal reflux disease. The principal risk factors for esophageal cancer are cigarette smoking and alcohol consumption, reflux disease, and obesity. In tumors without local invasion or distant metastases, surgery remains the treatment option of choice, although there are considerable differences of opinion regarding the roles of chemotherapy and radiotherapy. A wide variety of endoscopic treatments are available for dysplastic lesions and palliation. Despite the availability of increasingly complex imaging modalities and expensive and possibly ineffective attempts at screening, the evidence base is conflicted and the prognosis remains poor. However, from a recent large systematic review, three clear recommendations can be made, ie, use of endoscopic resection for high grade dysplasia, use of radiofrequency ablation for residual premalignant lesions, and, finally, prevention of risk factors for cancer, such as smoking, alcohol consumption, and obesity.

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“…This technique is inexpensive, easy to do, and suitable for short, bulky tumors. Alcohol injections have been shown to relieve dysphagia in over 80% of patients, and results have been comparable with those from laser treatment [38][39][40]. Endoscopic injection therapy can be used to re-open stents occluded by tissue overgrowth or ingrowth.…”

Section: Endoscopic Injection Therapymentioning

confidence: 99%

New approach to malignant strictures of the esophagus

Dua

2003

Curr Gastroenterol Rep

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Primary esophageal cancer is the most common cause of malignant esophageal stricture. Prognosis and treatment outcomes vary with the stage of the disease. Endoscopic ultrasound has a high accuracy rate for local and regional staging. Surgery is curative for early cancer. Endoscopic mucosal resection, photodynamic therapy, or brachytherapy can be used with curative intent for early cancer, especially in patients with comorbid conditions precluding surgery. Unfortunately, the majority of patients with esophageal cancer present with advanced disease. The primary aim in these patients is to alleviate symptoms with a minimum of side effects and reinterventions. Palliative surgery or chemoradiotherapy can be associated with high morbidity and mortality rates. Several endoscopic techniques for palliation are available, and all have the potential of significantly improving swallowing. The choice of a particular endoscopic approach is usually determined by local expertise and characteristics of the stricture.

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Palliation of Malignant Oesophageal Obstruction by Endoscopic Alcohol Injection

Cited by 61 publications

References 0 publications

Palliative therapy

Palliative therapy

Treatment of squamous cell and adenocarcinoma of the esophagus

New approach to malignant strictures of the esophagus

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