title: Electrochemical therapy in palliative treatment of malignant dysphagia: a pilot study.
abstract: OBJECTIVE
  Electrochemical therapy (ECT), a method based on the application of a low-level direct current, was employed in this study to relieve severe dysphagia. In addition, we aimed to assess the efficacy, safety and requirements for follow-up re-interventions.
  
  
  METHODS
  Sixteen patients with inoperable and circumferential malignant stenosis of the esophagus were palliated by ECT at presentation and then repeatedly whenever tumor growth and dysphagia recurred. The electrode was inserted and placed at the level of stenosis under fluoroscopic guidance, and an electric quantity of 300-560 coulombs (5-6.5 V; 60-90 mA) was given. When total luminal occlusion was found, prior balloon dilatation enabled insertion of the electrode. Patients with squamous cell carcinoma also received external beam radiotherapy of 20-30 Gy in 10 daily fractions. Dysphagia was graded on a scale of O to 4 (O = normal; 4 = complete dysphagia), and follow-up esophagograms were obtained for response evaluation.
  
  
  RESULTS
  The severity of dysphagia decreased by 1-4 (median: 2) grades with an improvement in 6 patients with totally obstructing lesions. Dysphagia recurred in all but 1 patient after a median interval of 10 weeks, but was easily treated with repeat ECT sessions. However, 2 patients became unresponsive to ECT after 7 and 3 months of therapy, respectively. There were no ECT-related complications.
  
  
  CONCLUSIONS
  In conclusion, this pilot study suggests that electrochemical therapy may provide safe and effective palliation of narrowing and circumferential esophageal carcinoma. It requires repeat interventions and dilatation expertise is necessary for insertion of the electrode through the totally obstructing lesion.
authors.affiliation: Department of General and Transplantation Surgery, University Hospital, Szczecin, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Wojcicki
authors.forename: R
authors.initials: R
authors.lastname: Kostyrka
authors.forename: B
authors.initials: B
authors.lastname: Kaczmarek
authors.forename: J
authors.initials: J
authors.lastname: Kordowski
authors.forename: M
authors.initials: M
authors.lastname: Romanowski
authors.forename: M
authors.initials: M
authors.lastname: Kaminski
authors.forename: J
authors.initials: J
authors.lastname: Klonek
authors.forename: S
authors.initials: S
authors.lastname: Zielinski
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000532:radiotherapy; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000150:complications / Q000532:radiotherapy; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects