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Endoscopic Management of Malignant Esophageal Strictures

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Multiple therapeutic options are available for palliation of dysphagia, being an important part of managing patients with incurable esophageal cancer.

The placement of self-expandable metal stents (SEMS) is currently the most favorable treatment in these patients, ensuring an immediate relief of dysphagia and an improvement of the quality of life. It is better than photodynamic therapy, laser therapy, and endoscopic cryoablation therapy that require repeated endoscopic sessions causing discomfort for the patient. Brachytherapy might be considered an alternative or in addition to stenting in malignant dysphagia, in patients with better prognosis.

Several self-expandable stents are commercially available; statistically significant differences among stents in efficacy and safety have not been demonstrated. Unfortunately, SEMS placement is not without downsides. Hemorrhage, fistula formation, perforation, and retrosternal pain have been reported. Recurrent dysphagia due to tissue in- and overgrowth has been a major drawback of uncovered and partially covered SEMS. A disadvantage of fully covered SEMS is a high risk of migration. Hypopharyngeal stenosis or strictures of the cervical esophageal have traditionally been considered more difficult to manage; in these cases, the choice of the right stent is essential to avoid serious adverse events.

Routinely stent placement as “bridge to surgery” or prior to preoperative chemoradiotherapy in patients with potentially curable disease has not been recommended because of high incidence of complications and an adverse impact on oncological outcomes.

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Authors and Affiliations

  1. Department of Gastroenterology, General Hospital-ASL 1 Imperiese, Sanremo, IM, Italy

    Massimo Conio, Mattia Crespi & Antonella De Ceglie

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  1. Massimo Conio
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  2. Mattia Crespi
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  3. Antonella De Ceglie
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Correspondence to Massimo Conio .

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Editors and Affiliations

  1. Division of Gastroenterology and Gastrointestinal Endoscopy IRCCS, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA

    Michael B. Wallace

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  1. Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

    Michael B. Wallace

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Conio, M., Crespi, M., De Ceglie, A. (2022). Endoscopic Management of Malignant Esophageal Strictures. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-56993-8_50

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  • DOI: https://doi.org/10.1007/978-3-030-56993-8_50

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