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Palliative endoscopic interventions in esophageal cancer

Palliative endoskopische Interventionsmöglichkeiten beim Ösophaguskarzinom

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Zusammenfassung

GRUNDLAGEN: Nach wie vor wird das Ösophaguskarzinom bei vielen Patienten erst in einem nicht mehr kurativ resektablem Stadium diagnostiziert. Ziel der Palliation ist eine rasche und anhaltende Beseitigung der Dysphagie bei gleichzeitig bestmöglicher Lebensqualität. METHODIK: Pubmed-unterstützte Literatursuche bezüglich der verschiedenen palliativen endoskopischer Therapieoptionen beim fortgeschrittenen Ösophaguskarzinom. ERGEBNISSE: Neben der Intubation des Ösophagus mittels selbst-expandierender Metall- oder Plastik-Stents stehen mit dem Nd-YAG-Laser, der Argon-Plasma-Koagulation, der intratumoralen Ethanolinjektion und der photodynamischern Therapie auch endoluminale Verfahren zur lokalen Tumorreduktion zur Verfügung. SCHLUSSFOLGERUNGEN: Keine der derzeit verfügbaren endoskopischen Therapiemöglichkeiten zeigt sich gegenüber den anderen in allen Aspekten der Palliation überlegen. Für die Auswahl der richtigen Therapie sind Größe und Lokalisation des Tumors, die Lebenserwartung des Patienten, sowie die eigene Expertise zu berücksichtigen.

Summary

BACKGROUND: The majority of patients with esophageal cancer still present with non- curatively resectable disease. Aim of palliation is improving the quality of life by instant and durable dysphagia relief. METHODS: Pubmed based literature research on endoscopic palliation in esophageal malignancies. RESULTS: Nowadays, intubation of the esophagus is done by placement of self-expanding metal or plastic stents. Beside this, Nd-YAG Laser, Photodynamic therapy (PDT), argon plasma coagulation (APC) or endoscopic intratumoral ethanol-injection are available as endoluminal ablative treatment modalities. CONCLUSIONS: None of these endoscopic palliative modalities is superior in all aspects of palliation. The appropriate therapy depends on tumor size and localization as well as expected survival time and one's own experience.

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References

  • Sihvo EI, Luostarinen ME, Salo JA (2004) Fate of patients with adenocarcinoma of the esophagus and the esophagogastric junction: a population-based analysis. Am J Gastroenterol 99: 419–424

    Article  PubMed  Google Scholar 

  • Thompson AM, Rapson T, Gilbert FJ, Park KG (2004) Endoscopic palliative treatment for esophageal and gastric cancer: techniques, complications, and survival in a population-based cohort of 948 patients. Surg Endosc 18: 1257–1262

    Article  PubMed  CAS  Google Scholar 

  • Wenger U, Luo J, Lundell L, Lagergren J (2005) A nationwide study of the use of self-expanding stents in patients with esophageal cancer in Sweden. Endoscopy 37: 329–334

    Article  PubMed  CAS  Google Scholar 

  • Sabharwal T, Hamady MS, Chui S, Atkinson S, Mason R, Adam A (2003) A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut 52: 922–926

    Article  PubMed  CAS  Google Scholar 

  • Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ (2001) A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc 54: 145–153

    PubMed  CAS  Google Scholar 

  • Fleischer D, Kessler F, Haye O (1982) Endoscopic Nd: YAG laser therapy for carcinoma of the esophagus: a new palliative approach. Am J Surg 143: 280–283

    Article  PubMed  CAS  Google Scholar 

  • Shmueli E, Myszor MF, Burke D, Record CO, Matthewson K (1992) Limitations of laser treatment for malignant dysphagia. Br J Surg 79: 778–780

    Article  PubMed  CAS  Google Scholar 

  • Aly EA, Burgess P (2002) Use of laser in the relief of malignant dysphagia: a district hospital experience. Dig Surg 19: 3–8

    Article  PubMed  Google Scholar 

  • Spencer GM, Thorpe SM, Blackman GM, Solano J, Tobias JS, Lovat LB, Bown SG (2002) Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: a randomised study. Gut 50: 224–227

    Article  PubMed  CAS  Google Scholar 

  • Luketich JD, Christie NA, Buenaventura PO, Weigel TL, Keenan RJ, Nguyen NT (2000) Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period. Surg Endosc 14: 653–657

    Article  PubMed  CAS  Google Scholar 

  • Litle VR, Luketich JD, Christie NA, Buenaventura PO, Alvelo-Rivera M, McCaughan JS, Nguyen NT, Fernando HC (2003) Photodynamic therapy as palliation for esophageal cancer: experience in 215 patients. Ann Thorac Surg 76: 1687–1692; discussion 92–93

    Article  PubMed  Google Scholar 

  • Lightdale CJ, Heier SK, Marcon NE, McCaughan JS, Gerdes H, Overholt BF, Sivak MV, Stiegmann GV, Nava HR (1995) Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial. Gastrointest Endosc 42: 507–512

    Article  PubMed  CAS  Google Scholar 

  • Heindorff H, Wojdemann M, Bisgaard T, Svendsen LB (1998) Endoscopic palliation of inoperable cancer of the oesophagus or cardia by argon electrocoagulation. Scand J Gastroenterol 33: 21–23

    PubMed  CAS  Google Scholar 

  • Robertson GS, Thomas M, Jamieson J, Veitch PS, Dennison AR (1996) Palliation of oesophageal carcinoma using the argon beam coagulator. Br J Surg 83: 1769–1771

    Article  PubMed  CAS  Google Scholar 

  • Eriksen JR (2002) Palliation of non-resectable carcinoma of the cardia and oesophagus by argon beam coagulation. Dan Med Bull 49: 346–349

    PubMed  Google Scholar 

  • Spiller RC, Misiewicz JJ (1987) Ethanol-induced tumour necrosis for palliation of malignant dysphagia. Lancet 2: 792

    Article  PubMed  CAS  Google Scholar 

  • Nwokolo CU, Payne-James JJ, Silk DB, Misiewicz JJ, Loft DE (1994) Palliation of malignant dysphagia by ethanol induced tumour necrosis. Gut 35: 299–303

    Article  PubMed  CAS  Google Scholar 

  • Meunier B, Spiliopoulos Y, Stasik C, Lakéhal M, Malledant Y, Launois B (1996) Retrosternal bypass operation for unresectable squamous cell cancer of the esophagus. Ann Thorac Surg 62: 373–377

    Article  PubMed  CAS  Google Scholar 

  • Conlan AA, Nicolaou N, Hammond CA, Pool R, de Nobrega C, Mistry BD (1983) Retrosternal gastric bypass for inoperable esophageal cancer: a report of 71 patients. Ann Thorac Surg 36: 396–401

    Article  PubMed  CAS  Google Scholar 

  • Atkinson M, Ferguson R (1977) Fibreoptic endoscopic palliative intubation of inoperable oesophagogastric neoplasms. Br Med J 1: 266–267

    Article  PubMed  CAS  Google Scholar 

  • Ho KY, Samarasinghe DA, Nicholson GI, Lane MR (1995) Endoscopic palliation of oesophageal carcinoma with Atkinson prosthesis. J Gastroenterol Hepatol 10: 56–59

    PubMed  CAS  Google Scholar 

  • De Palma GD, di Matteo E, Romano G, Fimmano A, Rondinone G, Catanzano C (1996) Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study. Gastrointest Endosc 43: 478–482

    PubMed  CAS  Google Scholar 

  • Davies N, Thomas HG, Eyre-Brook IA (1998) Palliation of dysphagia from inoperable oesophageal carcinoma using Atkinson tubes or self-expanding metal stents. Ann R Coll Surg Engl 80: 394–397

    PubMed  CAS  Google Scholar 

  • Adam A, Ellul J, Watkinson AF, Tan BS, Morgan RA, Saunders MP, Mason RC (1997) Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement. Radiology 202: 344–348

    PubMed  CAS  Google Scholar 

  • Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF, Luketich JD (2001) Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg 71: 1797–1801; discussion 801–802

    Article  PubMed  CAS  Google Scholar 

  • McGrath JP, Browne M, Riordan C, Ravi N, Reynolds JV (2001) Expandable metal stents in the palliation of malignant dysphagia and oesophageal-respiratory fistulae. Ir Med J 94: 270–272

    PubMed  CAS  Google Scholar 

  • Homs MY, Steyerberg EW, Kuipers EJ, van der Gaast A, Haringsma J, van Blankenstein M, Siersema PD (2004) Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy 36: 880–886

    Article  PubMed  CAS  Google Scholar 

  • Saranovic DJ, Djuric-Stefanovic A, Ivanovic A, Masulovic D, Pesko P (2005) Fluoroscopically guided insertion of self-expandable metal esophageal stents for palliative treatment of patients with malignant stenosis of esophagus and cardia: comparison of uncovered and covered stent types. Dis Esophagus 18: 230–238

    Article  PubMed  Google Scholar 

  • Homs MY, Steyerberg EW, Eijkenboom WM, Tilanus HW, Stalpers LJ, Bartelsman JF, van Lanschot JJ, Wijrdeman HK, Mulder CJ, Reinders JG, Boot H, Aleman BM, Kuipers EJ, Siersema PD (2004) Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet 364: 1497–1504

    Article  PubMed  Google Scholar 

  • Verschuur EM, Homs MY, Steyerberg EW, Haringsma J, Wahab PJ, Kuipers EJ, Siersema PD (2006) A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc 63: 134–140

    Article  PubMed  Google Scholar 

  • Mayoral W, Fleischer D, Salcedo J, Roy P, Al-Kawas F, Benjamin S (2000) Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer. Gastrointest Endosc 51: 556–559

    Article  PubMed  CAS  Google Scholar 

  • McManus K, Khan I, McGuigan J (2001) Self-expanding oesophageal stents: strategies for re-intervention. Endoscopy 33: 601–604

    Article  PubMed  CAS  Google Scholar 

  • Song HY, Do YS, Han YM, Sung KB, Choi EK, Sohn KH, Kim HR, Kim SH, Min YI (1994) Covered, expandable esophageal metallic stent tubes: experiences in 119 patients. Radiology 193: 689–695

    PubMed  CAS  Google Scholar 

  • Dua KS, Kozarek R, Kim J, Evans J, Medda BK, Lang I, Hogan WJ, Shaker R (2001) Self-expanding metal esophageal stent with anti-reflux mechanism. Gastrointest Endosc 53: 603–613

    Article  PubMed  CAS  Google Scholar 

  • Shim CS, Jung IS, Cheon YK, Ryu CB, Hong SJ, Kim JO, Cho JY, Lee JS, Lee MS, Kim BS (2005) Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endoscopy 37: 335–339

    Article  PubMed  CAS  Google Scholar 

  • Homs MY, Wahab PJ, Kuipers EJ, Steyerberg EW, Grool TA, Haringsma J, Siersema PD (2004) Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial. Gastrointest Endosc 60: 695–702

    Article  PubMed  Google Scholar 

  • Burt M, Diehl W, Martini N, Bains MS, Ginsberg RJ, McCormack PM, Rusch VW (1991) Malignant esophago-respiratory fistula: management options and survival. Ann Thorac Surg 52: 1222–1228; discussion 8–9

    Article  PubMed  CAS  Google Scholar 

  • Raijman I, Siddique I, Ajani J, Lynch P (1998) Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc 48: 172–179

    Article  PubMed  CAS  Google Scholar 

  • Morgan RA, Ellul JP, Denton ER, Glynos M, Mason RC, Adam A (1997) Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses. Radiology 204: 527–532

    PubMed  CAS  Google Scholar 

  • Siersema PD, Schrauwen SL, van Blankenstein M, Steyerberg EW, van der Gaast A, Tilanus HW, Dees J; Rotterdam Esophageal Tumor Study Group (2001) Self-expanding metal stents for complicated and recurrent esophagogastric cancer. Gastrointest Endosc 54: 579–586

    Article  PubMed  CAS  Google Scholar 

  • Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB (2004) Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 232: 252–259

    Article  PubMed  Google Scholar 

  • Costamagna G, Shah SK, Tringali A, Mutignani M, Perri V, Riccioni ME (2003) Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures. Surg Endosc 17: 891–895

    Article  PubMed  CAS  Google Scholar 

  • Evrard S, Le Moine O, Lazaraki G, Dormann A, El Nakadi I, Devière J (2004) Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc 60: 894–900

    Article  PubMed  Google Scholar 

  • Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61: 891–896

    Article  PubMed  Google Scholar 

  • Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J (2005) Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 79: 398–403; discussion 4

    Article  PubMed  Google Scholar 

  • Hunerbein M, Stroszczynski C, Moesta KT, Schlag PM (2004) Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 240: 801–807

    Article  PubMed  Google Scholar 

  • Radecke K, Gerken G, Treichel U (2005) Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 61: 812–818

    Article  PubMed  Google Scholar 

  • Bethge N, Vakil N (2001) A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction. Am J Gastroenterol 96: 1350–1354

    Article  PubMed  CAS  Google Scholar 

  • Dormann AJ, Eisendrath P, Wigginghaus B, Huchzermeyer H, Devière J (2003) Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy 35: 207–211

    Article  PubMed  CAS  Google Scholar 

  • Yano T, Muto M, Minashi K, Ohtsu A, Yoshida S (2005) Photodynamic therapy as salvage treatment for local failures after definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc 62: 31–36

    Article  PubMed  Google Scholar 

  • Carazzone A, Bonavina L, Segalin A, Ceriani C, Peracchia A (1999) Endoscopic palliation of oesophageal cancer: results of a prospective comparison of Nd:YAG laser and ethanol injection. Eur J Surg 165: 351–356

    Article  PubMed  CAS  Google Scholar 

  • Harbord M, Dawes RF, Barr H, Giovannini M, Viens P, Eysselein V, Mishra L, Orenberg EK, Bown SG (2002) Palliation of patients with dysphagia due to advanced esophageal cancer by endoscopic injection of cisplatin/epinephrine injectable gel. Gastrointest Endosc 56: 644–651

    Article  PubMed  Google Scholar 

  • Monga SP, Wadleigh R, Sharma A, Adib H, Strader D, Singh G, Harmon JW, Berlin M, Monga DK, Mishra L (2000) Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer. Am J Clin Oncol 23: 386–392

    Article  PubMed  CAS  Google Scholar 

  • Bergquist H, Wenger U, Johnsson E, Nyman J, Ejnell H, Hammerlid E, Lundell L, Ruth M (2005) Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus 18: 131–139

    Article  PubMed  CAS  Google Scholar 

  • Sihvo EI, Pentikäinen T, Luostarinen ME, Rämö OJ, Salo JA (2002) Inoperable adenocarcinoma of the oesophagogastric junction: a comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis. Eur J Surg Oncol 28: 711–715

    Article  PubMed  CAS  Google Scholar 

  • Polinder S, Homs MY, Siersema PD, Steyerberg EW (2004) Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer. Br J Cancer 90: 2067–2072

    PubMed  CAS  Google Scholar 

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  1. Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    F. B. Langer & J. Zacherl

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  1. F. B. Langer
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  2. J. Zacherl
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Langer, F., Zacherl, J. Palliative endoscopic interventions in esophageal cancer. Eur Surg 39, 288–294 (2007). https://doi.org/10.1007/s10353-007-0360-2

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