title: Palliative treatment of unresectable esophagogastric junction tumors: balloon dilation combined with chemotherapy and/or radiation therapy and metallic stent placement.
abstract: OBJECTIVE
  To prospectively evaluate an algorithm for palliative treatment of unresectable esophagogastric junction tumors based on stricture length.
  
  
  METHODS
  Eighty-six patients with malignant esophagogastric obstructions were referred to the interventional radiology department for balloon dilation or stent placement due to dysphagia. Balloon dilation was performed in patients (n = 39) with a short segmental (< or =4 cm) stricture, whereas stent placement was performed in patients (n = 47) with a long segmental (>4 cm) stricture. In the balloon group, 16 patients with esophageal carcinoma underwent both chemotherapy and radiation therapy, whereas 23 patients with gastric carcinoma underwent only chemotherapy.
  
  
  RESULTS
  Technical success was achieved in all procedures in all patients (100%). The overall clinical success rate of balloon dilation and stent placement for a malignant esophagogastric junction was 87% (75 of 86 patients). Clinical success was achieved in 29 of the 39 patients in the balloon group (74%) and 98% (46 of the 47 patients in the stent group (98%). The overall complication rate was 21% (18 of 86 patients). Seventeen complications, which consisted of reflux (n = 8), migration (n = 6), tumor overgrowth (n = 2), and tissue hyperplasia (n = 1), occurred after stent placement, whereas one complication (intramural rupture) occurred after balloon dilation. The median symptom-free and survival periods were 120 (95% confidence interval: 114, 263) and 147 (95% confidence interval: 98, 196) days, respectively.
  
  
  CONCLUSIONS
  The treatment strategies seem to be reasonable for palliative therapy in patients with malignant esophagogastric junction obstructions. However, further investigations are needed to minimize the drawbacks of the methods and to determine optimal treatments in patients with unresectable malignant esophagogastric junction obstructions.
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Song
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Kyung Rae
authors.initials: KR
authors.lastname: Kim
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Kim
authors.forename: Seung-Il
authors.initials: SI
authors.lastname: Park
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Eugene
authors.initials: E
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D002404:Catheterization; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003287:Contrast Media; D004938:Esophageal Neoplasms / Q000628:therapy*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D015607:Stents; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate