Öz
Abstract
Aim. Esophageal cancer is common in Turkey. Many of the patients apply to clinics at the advanced stage and curative treatment is usually not possible. Mean survival ranges between 4 to 6 months in these patients. Self-expandable metallic stents (SEMS) are used to relieve dysphagia and increase quality of the life in inoperable esophageal cancer patients and are important in palliation. The aim of this study is to evaluate the efficacy and complications of self-expandable esophageal metallic stents as a palliative treatment option in patients with advanced esophageal tumors narrowing the esophageal lumen. Method. SEMS was placed to nineteen patients with dysphagia in Akdeniz University Hospital between the time 2006 and 2010. Dysphagia was graded before and after stent placement. Complications were evaluated after the stent placement. Results. The stent placement procedure was technically successful in all of the patients. Dysphagia decreased after insertion of self-expandable esophageal metallic stents from grade 4 to grade 2 in 47.4% of patients and from grade 3 to grade 2 in 52.6% of patients. No life-threatening complications occurred. Conclusion. Undernutrition appears to be closely related with poor out-come of esophageal cancer. This study suggested that palliative stent placement in inoperable esophageal cancer was effective to relieve dysphagia.
Keywords: Esophageal cancer, stent placement, palliative treatment
Özet
Giriş. Özofagus kanseri Türkiye’de yaygın görülür. Hastaların büyük çoğunluğu ileri evrede doktora başvurmakta ve küratif tedavi mümkün olamamaktadır. Bu hastalarda ortalama yaşam süresi 4 ile 6 ay arasında değişmektedir. İnoperaable özofagus kanserlerinde disfaji semptomlarında rahatlama ve yaşam kalitesini yükseltme amacıyla kendiliğinden genişleyebilen metalik stent uygulaması önemli bir palyasyon sağlamaktadır. Bu çalışmanın amacı özofagus lümenini daraltan ileri evre tümörlerin neden olduğu disfaji semptomlarının palyasyonunda kendiliğinden genişleyebilen metalik stent uygulamasının yararları ve komplikasyonları değerlendirildi. Yöntem. Akdeniz Üniversitesi Tıp Fakültesi Endoskopi Ünitesinde 2006 ile 2010 arasında ondokuz disfaji nedeniyle başvuran hastaya kendiliğinden genişleyebilen stent uygulandı. Disfaji derecesi uygulama öncesi ve sonrası değerlendirildi. Stent uygulaması sonrası komplikasyonlar değerlendirildi. Bulgular. Tüm hastalarda stent yerleştirilmesi teknik olarak başarılı oldu. Stent sonrası disfaji hastaların %47,4’ünde grade 4’den grade 2’ye ve %52,6’sında grade 3’den grade 2’ye geriledi. İşleme bağlı hayatı tehdit edici komplikasyon görülmedi. Sonuç. Özofagus kanserlerinde yetersiz beslenme ile kötü sonucun yakın ilişkili olduğu görülmektedir. Bu çalışma ile inoperable özofagus kanserlerindeki disfajinin palyasyonunda kendiliğinden genişleyebilen metalik stent uygulamasının etkili olduğu gözlemlenmiştir.
Anahtar sözcükler: Özofagus kanseri, stent yerleştirilmesi, palyatif tedavi
Anahtar Kelimeler
Kaynakça
- Sundelöf M, Ye W, Dickman PW, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer 2002; 99: 751-4.
- Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ.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 2001; 54: 145-53.
- Riccardi D, Allen K. Nutritional management of patients with esophageal and esophagogastric junction cancer. Cancer Control 1999; 6: 64-72.
- Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329: 1302-7.
- Baron TH. A practical guide for choosing an expandable metal stent for GI malignancies: is a stent by any other name still a stent? Gastrointest Endosc 2001; 54: 269-72.
- Tan BS, Mason RC, Adam A. Minimally invasive therapy for advanced oesophageal malignancy. Clin Radiol 1996; 51: 828-36.
- Winkelbauer FW, Schöfl R, Niederle B, Wildling R, Thurnher S, Lammer J. Palliative treatment of obstructing esophageal cancer with nitinol stents: value, safety, and long-term results. AJR Am J Roentgenol 1996; 166: 79-84.
- Watson A. Self-expanding metal oesophageal endoprostheses: which is best? Eur J Gastroenterol Hepatol 1998; 10: 363-5.
- Watkinson AF, Ellul J, Entwistle K, Mason RC, Adam A. Esophageal carcinoma: initial results of palliative treatment with covered self-expanding endoprostheses. Radiology 1995; 195: 821-7.
- Yang HS, Zhang LB, Wang TW, Zhao YS, Liu L. Clinical application of metallic stents in treatment of esophageal carcinoma. World J Gastroenterol 2005; 11: 451-3.
- Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329: 1302-7.
- Homs MY, Eijkenboom WM, Coen VL, Haringsma J, van Blankenstein M, Kuipers EJ, Siersema PD. High dose rate brachytherapy for the palliation of malignant dysphagia. Radiother Oncol 2003; 66: 327-32.
- Bader M, Dittler HJ, Ultsch B, Ries G, Siewert JR. Palliative treatment of malignant stenoses of the upper gastrointestinal tract using combination of laser and afterloading therapy. Endoscopy 1986; 18: 27-31.
- Sargeant IR, Loizou LA, Tobias JS, Blackman G, Thorpe S, Bown SG. Radiation enhancement of laser palliation for malignant dysphagia: a pilot study. Gut 1992; 33: 1597-601.
- Lindberg CG, Cwikiel W, Ivancev K, Lundstedt C, Stridbeck H, Tranberg KG. Laser therapy and insertion of Wallstents for palliative treatment of esophageal carcinoma. Acta Radio 1991; 32: 345-8.
- Bethge N, Sommer A, Vakil N. Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents. Am J Gastroenterol 1998; 93: 1829-32.
- Jacobson BC, Hirota W, Baron TH, Leighton JA, Faigel DO; Standards of Practice Committee. American Society for Gastrointestinal Endoscopy. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2003; 57: 817-22.
- Acunaş B, Rozanes I, Akpinar S, Tunaci A, Tunaci M, Acunaş G. Palliation of malignant esophageal strictures with self-expanding nitinol stents: drawbacks and complications. Radiology 1996; 199: 648.
- Sundelöf M, Ringby D, Stockeld D, Granström L, Jonas E, Freedman J. Palliative treatment of malignant dysphagia with self-expanding metal stents: a 12-year experience. Scand J Gastroenterol 2007; 42: 11-6.
- Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ. 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 2001; 54: 145-53.
- Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc 1998; 48: 172.
Öz
Abstract
Background: Esophageal cancer is common in Turkey and diagnosis is usually late and the mean survival ranges from 4 to 6 months. Relief of dysphagia and increase in quality of the life are the targets of palliative therapy. The aim of this study was to evaluate the efficacy and complications of self - expandable esophageal metallic stents in patients with advanced esophageal tumors, which is a palliative treatment option.
Method: Nineteen patients with inoperable esophageal cancer, who applied to endoscopic unit of medical faculty of Akdeniz University between 2006 and 2010, were evaluated retrospectively. Self - expandable esophageal metallic stents were located to all of them with complaints of dysphagia. Dysphagia was graded before and after stent placement. Complications of stent placement were also evaluated.
Anahtar Kelimeler
Kaynakça
- Sundelöf M, Ye W, Dickman PW, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer 2002; 99: 751-4.
- Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ.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 2001; 54: 145-53.
- Riccardi D, Allen K. Nutritional management of patients with esophageal and esophagogastric junction cancer. Cancer Control 1999; 6: 64-72.
- Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329: 1302-7.
- Baron TH. A practical guide for choosing an expandable metal stent for GI malignancies: is a stent by any other name still a stent? Gastrointest Endosc 2001; 54: 269-72.
- Tan BS, Mason RC, Adam A. Minimally invasive therapy for advanced oesophageal malignancy. Clin Radiol 1996; 51: 828-36.
- Winkelbauer FW, Schöfl R, Niederle B, Wildling R, Thurnher S, Lammer J. Palliative treatment of obstructing esophageal cancer with nitinol stents: value, safety, and long-term results. AJR Am J Roentgenol 1996; 166: 79-84.
- Watson A. Self-expanding metal oesophageal endoprostheses: which is best? Eur J Gastroenterol Hepatol 1998; 10: 363-5.
- Watkinson AF, Ellul J, Entwistle K, Mason RC, Adam A. Esophageal carcinoma: initial results of palliative treatment with covered self-expanding endoprostheses. Radiology 1995; 195: 821-7.
- Yang HS, Zhang LB, Wang TW, Zhao YS, Liu L. Clinical application of metallic stents in treatment of esophageal carcinoma. World J Gastroenterol 2005; 11: 451-3.
- Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329: 1302-7.
- Homs MY, Eijkenboom WM, Coen VL, Haringsma J, van Blankenstein M, Kuipers EJ, Siersema PD. High dose rate brachytherapy for the palliation of malignant dysphagia. Radiother Oncol 2003; 66: 327-32.
- Bader M, Dittler HJ, Ultsch B, Ries G, Siewert JR. Palliative treatment of malignant stenoses of the upper gastrointestinal tract using combination of laser and afterloading therapy. Endoscopy 1986; 18: 27-31.
- Sargeant IR, Loizou LA, Tobias JS, Blackman G, Thorpe S, Bown SG. Radiation enhancement of laser palliation for malignant dysphagia: a pilot study. Gut 1992; 33: 1597-601.
- Lindberg CG, Cwikiel W, Ivancev K, Lundstedt C, Stridbeck H, Tranberg KG. Laser therapy and insertion of Wallstents for palliative treatment of esophageal carcinoma. Acta Radio 1991; 32: 345-8.
- Bethge N, Sommer A, Vakil N. Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents. Am J Gastroenterol 1998; 93: 1829-32.
- Jacobson BC, Hirota W, Baron TH, Leighton JA, Faigel DO; Standards of Practice Committee. American Society for Gastrointestinal Endoscopy. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2003; 57: 817-22.
- Acunaş B, Rozanes I, Akpinar S, Tunaci A, Tunaci M, Acunaş G. Palliation of malignant esophageal strictures with self-expanding nitinol stents: drawbacks and complications. Radiology 1996; 199: 648.
- Sundelöf M, Ringby D, Stockeld D, Granström L, Jonas E, Freedman J. Palliative treatment of malignant dysphagia with self-expanding metal stents: a 12-year experience. Scand J Gastroenterol 2007; 42: 11-6.
- Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ. 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 2001; 54: 145-53.
- Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc 1998; 48: 172.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Haziran 2011 |
| Yayımlandığı Sayı | Yıl 2011Cilt: 33 Sayı: 2 |