Laser Therapy and Insertion of Wallstents for Palliative Treatment of Esophageal Carcinoma

Lindberg, C.-G.; Cwikiel, Wojciech; Ivancev, Krasnodar; Lundstedt, C.; Stridbeck, H.; Tranberg, Karl‐Göran

doi:10.1177/028418519103200501

Cited by 11 publications

(5 citation statements)

References 16 publications

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“…2,[9][10][11][12] Indications for intubation and laser therapy essentially depend on tumor morphology: a stent has to be preferred in infiltrating tumors; and a laser has to be chosen in crumbly, easily bleeding and noncircumferential neoplasms because the stent needs a good anchorage. 2,[13][14][15][16][17] Moreover, laser therapy has to be employed in tumor overgrowth of the stent and in angulated cardia strictures because the stent is horizontally positioned and the functional results are poor. 18 Only intubation can be performed in esophageal stenosis due to a bronchial carcinoma and in esophago-respiratory fistulas.…”

Section: Discussionmentioning

confidence: 99%

Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia

Mosca

Consoli

Stracqualursi

et al. 2003

Diseases of the Esophagus

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Palliative treatment of malignant strictures of the esophagus and cardia is usually carried out by the endoscopic placement of a prosthesis. The aim of this retrospective study was to evaluate short- and long-term outcomes of the use of expandable stents, compared with conventional plastic prostheses. One hundred and thirteen endoscopic intubations were carried out in 120 patients affected by malignant stenosis of the esophagus and cardia using plastic prosthesis and self-expanding metal stents. Dysphagia was scored according to Atkinson and Ferguson's classification and the preoperative median score (3.6) was comparable in both groups. The technical success rate was 94.4% with plastic prosthesis and 93.7% with self-expanding metal stent while the functional success rate was, respectively, 85.2% and 88.8%. Three deaths occurred with plastic prostheses (4.4%), while no deaths were observed with metal stents. A comparative analysis of the results of this study suggests that the endoscopic placement of self-expanding metal stents is effective and safe and has to be preferred to the conventional plastic prosthesis for easier implantation and lower morbidity.

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Section: Discussionmentioning

confidence: 99%

Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia

Mosca

Consoli

Stracqualursi

et al. 2003

Diseases of the Esophagus

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“…The indications for prosthesis placement and laser therapy are essentially down to cancer morphology: the stent has to be preferred in infiltrating tumors, whereas laser treatment is considered best for soft, non‐constricting, non‐circumferential cancers with poor anchoring capabilities 6 , 11–15 …”

Section: Discussionmentioning

confidence: 99%

“…The lower morbidity rate is the main advantage of metallic self‐expanding stents, which are preferred to plastic prosthesis. However, technological improvements are necessary before these stents can reach optimal standards 6 , 10 , 15 , 21–25 …”

Section: Discussionmentioning

confidence: 99%

Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation

Mosca

Stracqualursi

Portale

et al. 2008

Diseases of the Esophagus

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Endoscopic tube implantations were carried out in 40 patients with malignant stenosis of the esophagus and gastric cardia using self-expanding metallic stents. The indications for endoscopic intubation were the advanced stage of the tumor in 27 cases and risk factors that made resection inadvisable in 13 cases. In three patients, it proved impossible to implant a stent endoscopically because we were not able to pass the guide wire through the stenosis, whereas correct stent placement was achieved in 37 cases. Functional results were good in 33 patients, but four patients did not show any improvement of symptoms. Complications occurred in nine patients (24.3%): two bleedings, three neoplastic obstructions, one food obstruction, and three distal dislodgements of the prosthesis were observed, but could be readily corrected. No deaths occurred. The median survival time was 151 days (range 25±545 days). This study suggests that endoscopic placement of metallic self-expanding stents is safe and is to be preferred to plastic stents for easier implantation and lower morbidity.

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“…Nonetheless, as experience with these stents grows, it has become clear they are not without problems. One frequent reason for loss of stent patency is tumour overgrowth [7][8][9]. In those stents designed with an open mesh or coil, tumour may grow in through the sides of the stent.…”

Section: Background and Aimmentioning

confidence: 99%

“…One option is coaxial placement of another stent [8][9][10]. Alternatively the obstructing tumour can be destroyed by thermal ablation using laser or argon plasma coagulation (APC) [8,[11][12][13][14]. Given the high cost of EMS, this is likely to be a more coste#ective solution and is the preferred approach in many centres.…”

Section: Background and Aimmentioning

confidence: 99%

Preserving the Integrity of Oesophageal Stents with Laser Therapy and Argon Plasma Coagulation: An In Vitro Study

Rajendran

Krasner

2000

Lasers Med Sci

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Thermal lasers and argon plasma coagulation are widely used in the treatment of stent overgrowth in patients with advanced oesophageal malignancy. The aim of treatment is to achieve patency while avoiding damage to the prosthesis. This experimental study was designed to determine the power and duration of application that can be safely tolerated by four di#erent types of oesophageal prostheses. Five stents were studied: wall stent; open metal mesh stent (uncovered Ultraflex); covered metal mesh stent (covered Ultraflex); Gianturco (Z-stent); Esophagocoil. Nd-YAG Laser, GaAlAs diode laser and argon plasma coagulation were applied in non-contact mode at gradually increasing power levels and duration and the e#ects were observed. The use of argon plasma coagulation on Esophagocoil stent seems safe in power settings of 100 W up to 10 s. The diode laser is intermediate in that Gianturco and Esophagocoil stents can withstand pulses of up to 50 W for about 2 s. The Nd-YAG laser is detrimental to most stents at power levels of 20 W. Only the Esophagocoil withstands Nd-YAG pulses of 60 W but only up to 1 s. Wallstent, open and membranecovered mesh stents perform poorly in that they can only tolerate up to 1.5 s of power at 25 W with the Diode and 1.0 s of power at 20 W with Nd-YAG laser. The use of di#erent thermal modalities on the five stents has indicated safe power limits and duration. Membrane-covered stents are always damaged by thermal laser application unless the membrane is truly transparent.

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Laser Therapy and Insertion of Wallstents for Palliative Treatment of Esophageal Carcinoma

Cited by 11 publications

References 16 publications

Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia

Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia

Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation

Preserving the Integrity of Oesophageal Stents with Laser Therapy and Argon Plasma Coagulation: An In Vitro Study

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