Endoscopic palliation for inoperable malignant dysphagia: long term follow up.

Maunoury, V.; Brunetaud, J. M.; Cochelard, D.; Boniface, B.; Cortot, Antoine; Paris, J. C.

doi:10.1136/gut.33.12.1602

Cited by 27 publications

(7 citation statements)

References 18 publications

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“…The mean pretreatment dysphagia score was 2.03 and the mean best post-treatment score was 1.05, giving a mean improvement of 0.98. The median number of treatments was 4 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The median interval between treatments was 3.5 weeks and median survival from the time of first laser was 5 months (range 1-56).…”

Section: Resultsmentioning

confidence: 99%

Laser Photocoagulation in the Treatment of Malignant Dysphagia

Hurley

Cade

1997

Australian and New Zealand Journal of Surgery

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Background: Dysphagia secondary to carcinoma of the oesophagus and gastric cardia is the principal symptom requiring palliation in those patients who present with late-stage disease or who are unfit for surgery. The primary aim of the present study was to determine the safety and efficacy of laser photocoagulation in the palliation of malignant dysphagia. Secondary aims were to look at reasons for failure and predictors of outcome; to determine the most appropriate second line therapy for treatment failures; and to look at the results of treatment for early stage disease. Methods: Sixty-seven patients treated over a 6-year period with endoscopic Nd:YAG laser photocoagulation were evaluated and the quality of swallowing assessed before and at intervals after treatment. Results: Ninety per cent of patients achieved successful initial palliation. This was sustained in 76% after 3 months of treatment. Within a month before death 71% of patients were palliated but 29% required the addition of second-line treatment to achieve this. Complications were infrequent. There were no deaths attributable to laser treatment. Five of 10 patients treated with radiotherapy developed fibrous stricturing that required endoscopic dilatation. No variables were independently predictive for treatment failure. Six patients with early stage disease experienced prolonged survival. Conclusions: We conclude that laser photocoagulation offers safe and effective palliation of malignant dysphagia in this group of patients and is appropriate as first-line therapy.

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Section: Resultsmentioning

confidence: 99%

Laser Photocoagulation in the Treatment of Malignant Dysphagia

Hurley

Cade

1997

Australian and New Zealand Journal of Surgery

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“…Only a small minority of patients are able to return to an entirely normal diet with the majority being limited to semisolids [22]. Three prospective randomised studies have reported that patients treated with laser achieve better palliation [23, 24, 25]. However, for smaller centres, intubation is likely to be the only treatment option [11]although it provides less quality of palliation and carries a higher complication rate.…”

Section: Discussionmentioning

confidence: 99%

Use of Laser in the Relief of Malignant Dysphagia: A District Hospital Experience

Aly¹,

Burgess²

2002

Dig Surg

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Background: Endoscopic laser treatment offers rapid relief from dysphagia. The major drawback of laser therapy is the need for repeated treatment at 4- to 6-week intervals. Laser therapy is often done in tertiary referral centres and is said to require special expertise that is not available in many peripheral hospitals. For smaller centres, intubation is likely to be the only treatment option even though it gives less quality of palliation. Aim: To report the experience of a district general hospital in laser treatment of malignant dysphagia. Methods: A retrospective study on patients who had laser therapy for relief from malignant dysphagia from march 1995 to January 2000 was performed in a district general hospital in the UK. Results: Forty patients (25 males and 15 females) with histologically proven oesophageal carcinoma were unsuitable for surgical resection. Trainees, under supervision, did 20% of the sessions. Treatment was done on a day case basis with no outpatient follow-up. The patients had direct access to the service whenever dysphagia got worse. The median number of sessions per patient was 4 (range 1–13). The median palliation period per session was 7 (range 1–32) weeks. The median total palliation period was 7 months. There was no procedure-related mortality. Conclusion: Laser therapy is a safe, easy to teach and learn technique for relief from malignant dysphagia. It can be done on a day case basis with minimum need for follow-up and hospital visits. Such a service could be provided in a district general hospital set-up once equipment and experience are available, thus saving patients from having to travel to specialist units.

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“…In fact, despite claims of the contrary, hard scientific data focusing on the quality of life following any treatment modality is virtually nonexisting. However, resection seems not to be necessary in order to relieve symptoms as some investigators have found a satisfactory palliation following the development of endoscopic proce dures, especially laser treatment [31][32][33][34],…”

Section: Discussionmentioning

confidence: 99%

Benefit of Resection in Palliative Surgery

Haugstvedt¹

1994

Dig Surg

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425 out of 1,165 patients with stomach cancer included in a national multicenter study received noncurative treatment: 182/425 had a gastric resection, 70/425 a bypass procedure and in 156/425 an explorative laparotomy was carried out. Palliative resections carried the same postoperative mortality rate as nonresectional procedures (9 vs. 10%). Given similar age, Karnofsky index and preoperative weight loss, resection doubled median survival (Cox proportional hazards model) both for stage III and for stage IV patients compared to no resection.

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Endoscopic palliation for inoperable malignant dysphagia: long term follow up.

Cited by 27 publications

References 18 publications

Laser Photocoagulation in the Treatment of Malignant Dysphagia

Laser Photocoagulation in the Treatment of Malignant Dysphagia

Use of Laser in the Relief of Malignant Dysphagia: A District Hospital Experience

Benefit of Resection in Palliative Surgery

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