Treatment of Esophagogastric Tumors

Palliative endoscopic treatment of esophagogastric cancer is now possible using expandable metal stents. The properties, advantages, and drawbacks of these stents have been extensively analyzed, and there is no doubt that they are now easy and safe to introduce, without serious morbidity. However, the frequency of persistent thoracic pain and delayed complications, as well as the high rate of repeat interventions required, justify limited use of the procedure. The major indication for the procedure is dysphagia due to cancer in the esophagus or at the cardia. Enteral stents have been used in the treatment of malignant duodenal or jejunal stenoses, but the results are poor. A promising new area is the treatment of benign stenoses using expandable and biodegradable stents. It may be possible to use this technique for surgical anastomoses after tumor resection.

Careful endoscopic analysis of the mucosal surface is necessary to establish the strict indications for endoscopic mucosal resection for mucosal malignancy. Biopsy evidence of the relation between lesion diameter, a depressed surface pattern and the depth of invasion into the submucosa, as well as the extent of regional or distant lymphatic invasion, provides the best guidelines for safe curative mucosectomy in gastric cancer. Endoscopic therapy is always safe in lesions less than 1cm in diameter; for other lesions, resection is safe when the depth of submucosal invasions is less than 300 μm. In other situations, surgery is preferable in patients who are otherwise in good health. In Japan, the results of the National Survey of Gastric Cancer, with cases detected by screening, confirmed the benefits of adherence to these guidelines; most patients were treated surgically, and only 7 % with endoscopic therapy.

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