Percutaneous gastrostomy compared with esophageal stenting for the treatment of esophageal cancer with dysphagia

2021 ◽  
Author(s):  
Tan Wang ◽  
Qiuyue Wen ◽  
Yingqiang Zhang ◽  
Jianpeng Yuan ◽  
Chongqing Gao ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Percutaneous Gastrostomy ◽  
Esophageal Stenting

scholarly journals Stenting of the esophagus in the course of the malignant dysphagia in elderly patients

2020 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Janusz Włodarczyk ◽  
◽  
Alicja Włodarczyk ◽  
Keyword(s):  
Lung Cancer ◽  
Esophageal Cancer ◽  
Elderly Patients ◽  
Clinical Management ◽  
Survival Rates ◽  
Palliative Therapy ◽  
Esophageal Stenosis ◽  
Safe Procedure ◽  
Malignant Dysphagia ◽  
Esophageal Stenting

Esophageal cancer is a disease with difficult clinical management, and palliative therapy is the only predominant treatment. This retrospective study analyses the results of clinical management of elderly patients (>75 years of age) who were treated with esophageal stenting for malignant dysphagia due to primary esophageal cancer, including squamous cell carcinoma (SCC), esophageal adenocarcinoma (EAC), as well as secondary esophageal malignant strictures due to non-small cell lung cancer (NSCLC). Patients with esophago-respiratory fistula (ERF) were also included in the study. This study included 166 patients aged 75–88 (mean age, 78) years. Nine (5.4%) patients had upper malignant esophageal stenosis, 48 (28.1%) had the middle, 43 (25.9%) in the lower part of the esophagus, 49 (29.5%) patients had EAC-related stenosis, and 17 (10.2%) patients reported lung cancer-related esophageal stenosis. Dysphagia was rated at 2.8 (range, 2–3) before stenting and at 1.2 (range, 1–2) after the stenting procedure. Seven (4%) patients experienced stenting migration, 12 (7.2%) had granulation tissue overgrowth and prosthesis obstruction, two (1.2%) developed respiratory failure, and one (0.6%) patient died. Twelve (7.2%) patients were treated for ERF with double-stenting, and three (1.8%) patients developed a secondary fistula after the stent implantation. The mean survival of patients with esophageal cancer and ERF was 101.8 days and 62.5 days, respectively. Esophageal stenting has proven a safe procedure in patients over 75 years of age. It has a low rate of stenting obstruction and migration. Patients with ERF are a particularly difficult group to treat, show very poor outcomes and short survival rates.

Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina

2020 ◽  
Vol 27 (4) ◽  
pp. 286-293
Author(s):  
Ajmal Khan ◽  
Zia Hashim ◽  
Zafar Neyaz ◽  
Aarti Agarwal ◽  
Samir Mohindra ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Advanced Esophageal Cancer ◽  
Esophageal Stenting

scholarly journals Palliative Radiotherapy Versus Esophageal Stent Placement in the Management of Patients With Metastatic Esophageal Cancer

2020 ◽  
Vol 18 (5) ◽  
pp. 569-574 ◽  
Author(s):  
Emily J. Martin ◽  
Andrew R. Bruggeman ◽  
Vinit V. Nalawade ◽  
Reith R. Sarkar ◽  
Edmund M. Qiao ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Esophageal Cancer ◽  
Pain Relief ◽  
Adverse Effects ◽  
Multivariable Analysis ◽  
Palliative Radiotherapy ◽  
Fistula Formation ◽  
Severe Adverse Effect ◽  
Esophageal Stenting ◽  
Over Time

Background: Patients with advanced esophageal cancer often experience pain and dysphagia, yet the optimal palliative management remains unclear. This retrospective study evaluated outcomes and adverse effects of palliative radiotherapy (RT) compared with esophageal stenting among a cohort of U.S. veterans with metastatic esophageal cancer. Patients and Methods: We identified 1,957 veterans in the United States with metastatic esophageal cancer who received palliative RT to the esophagus or esophageal stenting, and assessed the risks of severe adverse effects, including esophageal fistula formation, perforation, obstruction, hemorrhage, and esophagitis. We determined palliative efficacy by evaluating pain and dysphagia scores before and after intervention. Multivariable analyses were used to control for potential confounding factors. Results: In our cohort, 1,593 patients underwent RT and 364 underwent esophageal stenting. The cumulative incidence of any severe adverse effect at 6 months was higher among patients who received stents compared with those who received RT (21.7% vs 12.4%; P<.0010). In multivariable analysis, patients who received stents had an increased risk of any severe adverse effect, including fistula, perforation, and hemorrhage (all P<.0500). Multivariable analysis also showed that, compared with stenting, RT was associated with more rapid and durable pain relief (P<.0010) with no difference in relief of dysphagia over time when accounting for pretreatment dysphagia scores (P=.1029). Conclusions: Compared with esophageal stenting, RT was associated with a decreased risk of adverse effects, greater pain relief, and equivalent relief of moderate to severe dysphagia over time. Unmeasured patient- or tumor-related factors could have influenced the choice of intervention, thereby impacting our study outcomes. To our knowledge, this is the largest study to date analyzing the comparative risks and benefits of palliative RT and esophageal stenting among patients with metastatic esophageal cancer.

scholarly journals TRACHEO-ESOPHAGEAL STENTING IN THEIR TUMOR STENOSIS

2016 ◽  
Vol 175 (1) ◽  
pp. 74-77 ◽  
Author(s):  
E. A. Drobyazgin ◽  
Yu. V. Chikinev ◽  
I. E. Sudovykh ◽  
M. S. Anikina
Keyword(s):  
Esophageal Cancer ◽  
Respiratory Failure ◽  
Lymph Nodes ◽  
Stent Implantation ◽  
Esophageal Stenosis ◽  
Patient Treatment ◽  
Metastatic Lesions ◽  
The Right ◽  
Esophageal Stenting ◽  
Made In

The article presents the results of diagnostics and treatment of 6 patients, whom the trachea-esophageal stenting was performed (5 men, 1 woman). The age of patients was from 49 to 78 years old. The indication to stent implantation was in cases of esophageal cancer in 4 patients. Metastatic lesions of the lymph nodes of the mediastinum was the reason of esophageal stenosis after previously performed surgery (type of Lewes operation) in one case. Another reason of surgery was central cancer of the right lung with invasion to the mediastinum, trachea and esophagus compression in one patient. Treatment management was determined by presence of respiratory failure and dysphagia evidence. The trachea stenting was carried out as the first stage of treatment in case of respiratory failure. The esophageal stenting was made in case of dysphagia. There weren’t any complications. The trachea-esophageal patency was restored.

Preoperative esophageal stenting and short-term outcomes of surgery for esophageal cancer in a population-based study from Finland and Sweden

2019 ◽  
Vol 32 (11) ◽  
Author(s):  
Olli Helminen ◽  
Joonas H Kauppila ◽  
Ville Kytö ◽  
Jarmo Gunn ◽  
Jesper Lagergren ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Population Based ◽  
Advanced Esophageal Cancer ◽  
Short Term ◽  
Readmission Rates ◽  
Esophageal Stenting ◽  
Locally Advanced Esophageal Cancer

SUMMARY Population-based studies examining whether preoperative esophageal stenting influences the short-term outcomes after esophagectomy for esophageal cancer are lacking. This nationwide cohort combining data from Finland and Sweden was conducted to cover this gap. Patients with locally advanced esophageal cancer (T ≥ 3 and/or N ≥ 1, M0) who underwent esophagectomy between 2007 and 2014 were identified from nationwide registries in Finland and Sweden. The study exposure was preoperative stenting. The primary outcomes were 30- and 90-day mortality. Secondary outcomes were length of hospital stay and 30- and 90-day readmission rates. Multivariable Cox and linear regression analyses provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, comorbidity, tumor histology, year of surgery, and country. Of all 1029 participating patients who underwent surgery for locally advanced esophageal cancer, 127 (12.3%) had an esophageal stent inserted preoperatively. The absolute 30-day mortality rates were higher in stented patients (3.9%) than in those without a stent (1.6%), but the HR was not statistically significantly increased (HR 2.42; 95% CI 0.85–6.92). Similarly, the absolute 90-day mortality rates were increased after preoperative stenting (11.8%) compared to no stenting (7.0%), but again the HR was not statistically significantly increased (HR 1.68; 95% CI 0.95–2.98). Preoperative stenting did not influence length of hospital stay or readmission rates. The possibly increased short-term mortality after preoperative stenting in patients who undergo esophagectomy for esophageal cancer indicated in this study suggests a cautious approach to preoperative stenting until future research or meta-analyses provide a more definite answer.

scholarly journals Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

2012 ◽  
Vol 49 (3) ◽  
pp. 227-231 ◽  
Author(s):  
Ana Grilo ◽  
Carla Adriana Santos ◽  
Jorge Fonseca
Keyword(s):  
Body Mass Index ◽  
Esophageal Cancer ◽  
Body Mass ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Nutritional Support ◽  
Oral Intake ◽  
Upper Esophageal Sphincter ◽  
Advanced Esophageal Cancer ◽  
Endoscopic Gastrostomy ◽  
Esophageal Stenting

CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory parameters were roughly stable 1 and 3 months after the gastrostomy procedure. CONCLUSIONS: In patients with advanced upper esophageal cancer where only palliative treatment is possible, nutritional support is easily achieved with percutaneous endoscopic gastrostomy, allowing patients to be at homes, surviving a significant period of time. Percutaneous endoscopic gastrostomy feeding should be considered as standard definitive nutritional palliation in patients with upper esophageal cancer, unsuitable for esophageal stenting.

PS02.251: TWO CASES OF THE ADVANCED ESOPHAGEAL CANCER WHICH WAS ABLE TO IMPROVE QOL BY VATS- E AS PALLIATIVE OPERATION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 194-195
Author(s):  
Takayoshi Yoshida ◽  
Chunyong Lee ◽  
Takeshi Chouchi ◽  
Yusuke Komekami ◽  
Humio Konishi
Keyword(s):  
Esophageal Cancer ◽  
Esophageal Carcinoma ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Palliative Therapy ◽  
Stage Iv ◽  
Advanced Esophageal Cancer ◽  
Oral Ingestion ◽  
Palliative Operation ◽  
Esophageal Stenting

Abstract Background We often troubled with the choice of the treatment for unresctable or elderly advanced esophageal cancer on the keeping of quality of life (QOL) . There are few cases to impair QOL remarkably, because of dysphagia with esophageal stenosis or esophago-tracheal fistula after Chemo-Radiation Therapy. Esophageal bypass including palliative esopagectomy and esophageal stenting are used for the oral intake of these cases. Methods We reported two cases of the elderly advanced esophageal cancer which were effective for QOL improvement by palliative Video-Assisted Thoracic Surgery of Esophagus (VATS-E). Results Case 1: A 72-year-old woman admitted with dysphagia was found to have advanced esophageal carcinoma, clinical stage IV (T3N2M1). We initiated definitive chemotherapy with combined 5-fluorouracil and cisplatin, to which the patient showed confirmed partial response. Dysphagia was not improved enough. Therefore, she received esophageal stenting with the antireflex valve. She was not able to have enough oral ingestion after stenting. So VATS-esophageal bypass was performed four months after initial treatment. At 2 years after surgery, she was alive and underwent outpatients chemotherapy. She can have normal diet. Case 2: A 79-year-old woman admitted with vomiting and body weight loss. The diagnosis was advanced esophageal carcinoma, clinical stage IV (T4N3M0). She received definitive Docetaxel chemotherapy because of renal dysfunction, malnutrition, to which patient showed progressive disease. So, VATS-esophageal resection (D0) was performed about 1 months after chemotherapy. There were not postoperative complications. She can have rice gruel diet. Conclusion It is difficult to determine which treatment is better esophageal stenting and esophageal palliative operation, because there are few reports that compared the esophageal palliative operation. In late years, VATS become able to be carried out safely. It is lower invasive treatment than thoracotomy. VATS is one of the palliative therapy, but it is necessary to decide the indication carefully in the case that a prognosis is limited. We think that it is useful to have satisfaction of the oral ingestion for cases with the severe stenosis and refractory cases of stenting. It is thought that VATS-E have possibilities to become the useful choice as one means of the palliative operation in consideration of the general status and the prognosis of the patients. Disclosure All authors have declared no conflicts of interest.

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