Esophagogastric Carcinoma Research Articles

Combined transjugular intrahepatic portosystemic shunt and segmental Lipiodol hepatic artery embolization for the treatment of esophagogastric varices and hepatocellular carcinoma in patients with cirrhosis: preliminary report.

To evaluate the feasibility of combining placement of a transjugular intrahepatic portosystemic shunt (TIPS) and transcatheter hepatic segmental artery chemoembolization with Lipiodol (Seg-Lp-TAE) in patients with cirrhosis, esophagogastric varices, and hepatocellular carcinoma (HCC). Five patients with bleeding or large, high-flow esophagogastric varices and HCC were treated by TIPS and Seg-Lp-TAE. The mean portosystemic pressure gradient decreased from 20.8 cm H2O to 7.8 cm H2O after TIPS. The direct portogram and endoscopic examination revealed reduction of varices. At 6 months, one shunt had functionally occluded and could not be reopened; the other TIPS remained functional. Follow-up CT and the changes of alpha fetoprotein indicated effective therapy of Seg-Lp-TAE for HCC. Four patients are in stabile clinical condition at 9, 6, 1, and 1 months after the combined therapy; one died after 14 months due to decompensated liver cirrhosis. The combined therapy of TIPS and Seg-Lp-TAE will become a new interventional approach for patients with HCC and esophagogastric varices.

Dilatation and Prosthesis for Obstructing Esophagogastric Carcinoma

Palliation of dysphagia is necessary in many patients with esophageal cancer. Some patients can be managed with (repetitive) dilatation. Others require esophageal stenting with a custom-made plastic or commercially available prosthesis. The use of a metal expandable stent is new. A major indication is intubation with a fistula tube in case of bronchoesophageal fistulization.

Esophagogastric carcinoma: preoperative TNM classification with endosonography.

Endosonography (ES) was preoperatively performed in 91 patients with esophageal carcinoma and 80 with gastric carcinoma. Imaging findings were correlated with those from histologic analysis of resected specimens. ES was accurate in assessment of the depth of tumor infiltration. Early-stage disease could be distinguished from advanced carcinoma. Overall accuracy of ES was 90% for assessment of esophageal carcinoma and 83% for gastric carcinoma. Stenosis was a limiting factor for accurate staging (16% of cases). ES was reasonably accurate in assessment of lymph node metastasis: Overall accuracy was 82% for the esophagus and 66% for the stomach. For nonmetastatic lymph nodes, however, the accuracy was low (56% or less for both esophagus and stomach). Difficulties occurred in distinguishing inflammation from micrometastatic lymph node involvement. ES was not accurate for diagnosis of distant metastases due to limited penetration of ultrasound. Prevalence of lymph node metastasis increased with the progression of tumor infiltration. Technical improvements, such as a smaller diameter echoprobe, may further enhance diagnostic accuracy of ES.

Incidence of bacteremia with elective upper gastrointestinal endoscopic laser therapy

The incidence of bacteremia associated with endoscopy varies widely for different endoscopic procedures. This study prospectively evaluates the incidence of bacteremia in patients undergoing elective endoscopic laser therapy for two diseases of the upper gastrointestinal tract. In five patients (eight treatment sessions) with arteriovenous malformations, no bacteremia developed. In 15 patients (26 treatment sessions) with esophagogastric carcinoma, bacteremia developed at some time during the procedure in six (40%). However, bacteremia appeared to be associated with the endoscopic insertion through the tumor rather than the laser treatment per se. These findings lead us to conclude that for patients undergoing endoscopy and laser therapy for esophagogastric malignancy, but not for those being treated for arteriovenous malformations, antibiotic prophylaxis to prevent endocarditis may be indicated.