Pulsion intubation v. retrosternal gastric bypass for palliation of unresectable carcinoma of the upper thoracic oesophagus

Abstract

The optimum method of restoring the ability to swallow in patients with oesophageal carcinoma remains controversial. This prospective randomized study evaluates the palliative potential of pulsion intubation v. retrosternal gastric bypass of the excluded oesophagus in 106 patients with unresectable carcinoma; 55 patients were intubated and 51 patients treated by gastric bypass. The operative mortality and morbidity, palliation of dysphagia and postoperative nutritional status were compared in the 2 groups. Intubation resulted in 3 deaths (5.5 per cent) and gastric bypass in 4 deaths (7.8 per cent). Intubation was complicated by chest infection in 13 patients (24 per cent) but complications related to the procedure occurred in only 5 patients and included tube migration (2), respiratory obstruction (1), bleeding (2) and oesophageal perforation (1). Gastric bypass was complicated by chest infection in 14 patients (27 per cent), but procedure-related complications were common and included pneumothorax (3), wound infection (6), subphrenic abscess (2), anastomotic leak (5) and purulent neck discharge (3). Palliation of dysphagia was achieved in 93 per cent of patients following intubation and 92 per cent of patients following bypass. Nutritional status improved more rapidly following bypass. Nutritional status improved more rapidly following intubation. Pulsion intubation is the preferred palliative procedure because of fewer complications and a lesser degree of postoperative catabolism.

A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer

“…A prospective, randomised study (n = 106) comparing rigid intubation to palliative surgical bypass demonstrated comparable dysphagia relief for the two treatments but intubation was associated with significantly lower morbidity and mortality than surgery (9% versus 37% and 5.5% versus 7.8%, respectively). 265 Revisiting palliative surgery more recently in a retrospective study, Cantero and colleagues reported worse relief of dysphagia (76% versus 93%), with more complications (28% versus 0%) and a higher mortality (24% versus 6.6%) with palliative surgery than with SEMS. 266…”

Optimal management of esophageal cancer in Africa: A systemic review of treatment strategies

“…6,7,19,32,[44][45][46][47][48][49][50][51][52] All nine RCTs were single-center studies conducted in South Africa (Table 4). Three studies compared intubation with plastic stents to other treatments (dilation with bleomycin, 54 retrosternal gastric bypass 53 and SEMS 60 ), and two evaluated intubation combined with either chemotherapy, radiotherapy or chemoradiation as compared to intubation alone. 56,57 The remaining four RCTs investigated retrosternal bypass surgery with and without pyloroplasty 55 ; highdose-rate intraluminal brachytherapy (HDRILBT) dosing strategies 59 ; chemoradiotherapy vs radiotherapy alone 58 ; and HDRILBT with and without external beam radiotherapy (EBRT).…”

“…Retrosternal gastric bypass was investigated in two case series 34,35 and two RCTs from South Africa. 53,55 Early studies demonstrated the palliative benefit of this procedure, with operative mortality of 8% to 11%. 34,35,53,55 As rigid plastic stents became available, an…”

Bypasschirurgie zur Palliation

“…Bei 92 bzw. 93 der Patienten konnte die Dysphagie gebessert werden [2]. Seither hat die Bedeutung der palliativen Bypassanlage beim Ösophaguskarzinom durch die Weiterentwicklung alternativer Behandlungsverfahren ständig an Bedeutung verloren.…”