Recanalization of tube overgrowth: a useful new indication for laser in palliation of malignant dysphagia.
Overgrowth of an esophageal prosthesis by cancer is a late complication of insertion which presents a difficult management problem. We have treated 14 such patients; 9 had Celestin tubes and 5 Atkinson tubes in situ for a median of 7 months. The median patient age was 75 years; 3 had squamous cell carcinomas and 11 adenocarcinomas; 12 were at the lowest thoracic esophagus or cardia, and 2 were anastomotic. Eleven tubes were overgrown at the top, two at the bottom only, and one at both ends. Dysphagia was graded from 0 to 4 (0 = normal; 4 = dysphagia for liquids). All patients but one improved with treatment. The median pre-treatment grade was 4 (range, 2 to 4) and post-treatment was 2 (0 to 3). This improvement was significant (p less than 0.01) Wilcoxon-signal rank). Most patients required only one or two endoscopies. The median survival was 9 weeks from first laser session (range, 3 to 36 weeks). We feel these results justify laser treatment in most patients in whom cancer overgrowth causes blockage of an esophageal prosthesis.
Sargeant
I R
IR
National Medical Laser Centre, University College Hospital, London, United Kingdom.
Loizou
L A
LA
Tulloch
M
M
Thorpe
S
S
Brown
S G
SG
D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents