GASTROENTEROLOGY LITERATURE REVIEW
August 16, 2001
Adler EG, Baron TH. Endoscopic Palliation of Malignant Dysphagia. Mayo Clin Proc 2001;76:731-738.
1. Regarding the natural history of esophageal cancer
a. it is usually advanced by the time symptoms appear
b. it metastasizes via hematogenous spread
c. less than 50% of patients with symptomatic cancer are curable at the time of
diagnosis
d. recurrence at the anastomotic site occurs in about 20% of patients
e. 5-year survival of patients with esophageal cancer is less than 10%
2. PDT therapy
a. improves dysphagia in >60% of patients
b. destroys tissue to a depth of 2 to 5mm
c. compared to laser therapy, PDT offers longer lasting relief of dysphagia
d. PDT cannot be used for tumor ingrowth and overgrowth over a stent
e. May be used in superficial tumors in patients who are high risk surgical
candidates
f. After receiving the photosensitizing agents, patients are at risk of developing
skin reaction from light for 30-45 days, sunscreens are protective and allow patients to be exposed to sunlight.
True or False
3. Tracheoesophageal fistula complicating esophageal cancer is almost exclusively seen in patients with squamous cell carcinoma rather than adenocarcinoma.
4. Prior radiation therapy, chemotherapy or alcohol injection increases the risk of complications when placing self-expandable stents.
5. Alcohol injection therapy may be effective in palliating dysphagia, frequent chest pain and fever post procedure is observed
6. Advantages of coated self-expanding stents include that they can be used to close T-E fistula and ingrowth of tumor into the stent is prevented.
7. Surgery should be reserved for patients with potentially curable disease or those in whom non-surgical palliative options have failed.
8. Reestablishing the esophageal lumen patency to a size of 18mm or greater usually guarantees that the dysphagia will resolve or improve.
9. Tumor ingrowth into self-expandable stents can be managed by placing another stent inside the existing stent.
10. Procedures that may be useful for “debulking” the tumor include
a. endoscopic dilation
b. laser therapy
c. alcohol injection
d. photodynamic therapy
e. argon plasma coagulation
f. stent placement
11. Argon plasma coagulation
a. is a type of monopolar electrocautery
b. the plasma arc destroys tissue to a depth of 10-15mm
c. treatment allows recanalization of the esophagus in >80% of patients, after
the first treatment session
d. repeat therapy is often needed every 3 to 4 weeks.