title: Intratumoural injection of absolute alcohol in carcinoma of gastroesophageal junction for palliation of dysphagia.
abstract: BACKGROUND
  Ethanol-induced tumour necrosis (ETN) is a simple, readily available palliative treatment for patients with inoperable carcinoma of the oesophagus with poor performance status. In India, capital outlay needed for stenting or laser therapy is out of reach. Hence, we took up this study to calculate the effect of intratumoral injection of absolute alcohol in palliation of dysphagia due to carcinoma of the oesophagogastric junction and to monitor the improvement in quality of life (QOL).
  
  
  METHODS
  A total of 16 patients with a mean age of 56.2 ± 7.5 years with dysphagia due to unresectable malignant oesophageal strictures involving the oesophagogastric junction were included in the study. Six to ten cubic centimetres of absolute alcohol in 1 cc aliquots was injected circumferentially into the tumour at the point of luminal obstruction using disposable sclerosing needles (23G). During each follow up dysphagia grade, QOL score and complications, if any, were noted.
  
  
  RESULTS
  The mean alcohol injected per session was 6.9 ± 1.8 cc. The mean dysphagia grade improved from 5.5 ± 0.5 to 2.5 ± 1.1 before and after alcohol injection, respectively (p < 0.001). The time taken for recurrence of dysphagia ranged from 14 to 80 days with a median of 28 days. The mean QOL score assessed by modified EORTC questionnaire improved from a mean of 63.6 ± 6.9 to 92.6 ± 13.9 (p < 0.001). The dysphagia free survival ranged from 23 to 175 days with a mean of 71.2 days. Complications included oesophageal perforation in one patient and death in one patient.
  
  
  CONCLUSIONS
  The endoscopic intratumoral injection of absolute alcohol significantly improves dysphagia and QOL. It is inexpensive and easy to perform.
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
authors.forename: Vishnu Prasad Nelamangala
authors.initials: VP
authors.lastname: Ramakrishnaiah
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
authors.forename: J
authors.initials: J
authors.lastname: Ramkumar
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
authors.forename: Dinker
authors.initials: D
authors.lastname: Pai
keywords: endoluminal therapy; oesophageal cancer; palliative therapy