Abstract
BackgroundThe main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery.Patients and methodsAll the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS) were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation.ResultsOverall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35 – 93). The median number of sessions per patient was 2 (range 1 – 13 sessions). Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5–83 months) and the median survival from 1st palliation was 5 months (range 0.5–68.5 months).ConclusionEndoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.
Highlights
The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition
Release stents were used for strictures of the middle and upper oesophagus whilst distal-release stents were used for strictures of the gastro-oesophageal junction
The insertion of a self-expandable metal stent (SEMS) was mainly used for long tight circumferential strictures and in strictures that did not respond to other type of palliative treatment
Summary
The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery. Oesophageal cancer is a relatively rare disease. The average age standardised incidence rate in the EU for the year 2004, was 9.5 per 100,000 of male population and 8.7 per. 100,000 of female population [1]. At least 60% of patients with oesophageal cancer will be unsuitable for surgical resection either due to the stage of their disease or due to co-morbidity [2,3]. A large proportion of patients treated surgically, on the other hand, despite curative intention will turn out to have undergone a palliative resection [4]. The mean survival in these patients is only 4 – 6 months and the aim of their management is to improve the quality of life with palliative treatment
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