Palliation of Dysphagia in Carcinoma Esophagus

Abstract

Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient. This study aims to discuss the recent trends in palliation of dysphagia with promising results and the most suitable therapy for palliation of dysphagia in a given patient. A total of 64 articles that were published between years 2005 and 2015 on various modes of palliation of dysphagia in carcinoma esophagus were studied, which were mainly randomized and prospective studies. Through this study, we conclude that stents are the first choice of therapy for palliation, which is safe and cost-effective, and they can be combined with either radiotherapy or chemotherapy for long-term palliation of dysphagia with good quality of life. Radiotherapy can be used as a second-line treatment modality.

Palliation of Neoplastic Esophageal Strictures with Metallic Stents

“…A major complication of plastic stent was immigration and weren't very useful and effective for patients with esophageal neoplasm [17][18]. Self-expanding metallic stents [SEMS] had fewer complications compared to plastic stents [10,17]. SEMS are partially covered or fully covered.…”

“…SEMS should be placed at least after 6 weeks of the completion of chemo-radiotherapy for the prevention of the chest pain complication [15][16]21]. Some studies advised one barium esophagogram to define clearly narrowing of neoplastic lesion and presence of treacheo-esophageal fistula if there was any clinical suspicious by upper endoscopy [10,17]. Stent selection should be basis on tumor location, operator experience and expected survival [10,15,17].…”

“…SEMS is preferred for mid esophageal neoplasm but also can be used in each part of esophagus just considered at least 2cm away from upper esophageal sphincter [10,15]. SEMS should be placed at least after 6 weeks of the completion of chemo-radiotherapy for the prevention of the chest pain complication [15][16]21].…”

“…Maintenance of oral intake, nutritional support, manage mouth secretions, and reduce aspiration risk are essential for these patients [12][13]. Guidelines illustrated some indications for stent use in esophageal neoplasm including inoperable neoplastic obstruction, presence of neoplastic fistula or leakage or perforation, tumor recurrence and contraindication for chemo-radiotherapy [10,[15][16]. Contraindication of stents placement are curable neoplasm, uncorrectable coagulopathy, presence neoplasm within 2 cm of upper esophageal sphincter, within 6 weeks of chemoradiotherapy, ill patients, gastrointestinal obstruction, airway compression risk and sepsis [15][16].…”

“…5 year Survival of esophageal neoplasm is 5-15% [2,[4][5][6]. Palliative treatments like stents can be offered as the first choice at this stage [1][2][6][7][8][9][10][11][12]. Because most of patients suffer from dysphagia due to balk of tumor lesion and unfortunately are un-resectable at the diagnosis time [1][2].…”