[Palliative endoscopic treatments for esophageal cancers].
Esophageal cancer five-year survival has slightly increased during past 20 years (from 5 to 9%), but remains low. At time of diagnosis, 60% of the patients are only relevant for palliative therapy. Recent advances in therapeutic endoscopy have allowed improving dysphagia and quality of life. Endoscopic techniques are chosen according to tumor characteristics. According to French societies guidelines (FFCD, "Standards-Options-Recommandations" from FNCLCC, SNFGE) endoscopic treatment is a "gold standard" for metastatic patients with poor performance status, as well as oesophago-tracheal fistula. Expandable metal stent are efficient for malignant stenosis with lower morbidity and mortality than plastic prosthesis. Endoscopic placement of a covered self-expanding metal stent is the treatment of choice of an esophago-respiratory fistula. Dilatation is often the first step before other endoscopic therapies or medical treatment such as radiochemotherapy. Single dose brachytherapy could provide better long-term relief of dysphagia and fewer complications than stent placement, but is less widespread. Other techniques like bipolar electrocoagulation have restricted indications especially for circonferential stenosis of cervical esophagus. However, the main problem remains the dysphagia relapse after treatment.
Dahan
Laetitia
L
Service d'Hépatogastroentérologie et d'Oncologie Digestive, CHU Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 5. laetitia.dahan@ap-hm.fr
Ries
Pauline
P
Laugier
René
R
Seitz
Jean-François
JF
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004106:Dilatation / Q000379:methods; D004564:Electrocoagulation; D004938:Esophageal Neoplasms / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D006801:Humans; D053685:Laser Therapy; D010166:Palliative Care / Q000379:methods*; D015607:Stents
D000970:Antineoplastic Agents