Interventional Radiology for the Management of Inoperable Carcinoma of the Oesophagus

Objectives

Malignant dysphagia from oesophageal cancer aggravates malnutrition and tumor cachexia and eventually leads to the inability to swallow even saliva.

Self-expanding stents offer rapid relief of dysphagia and are a first-line method of palliation. They can be inserted under endoscopic or fluoroscopic guidance and the aim of this article is to highlight the options offered by interventional radiological methods with emphasis on tumors of the gastro-oesophageal junction (GOJ). In addition the latest advances in stent design are discussed.

References

• 1 Siersema P D, Marcon N, Vakil N. Metal stents for tumors of the distal esophagus and gastric cardia.  Endoscopy. 2003;  35 79-85
• 2 Lambert R. Treatment of esophagogastric tumors.  Endoscopy. 2003;  35 118-126
• 3 Laasch H U, Marriott A, Wilbraham L. et al . Effectiveness of open versus antireflux stents for palliation of distal esophageal carcinoma and prevention of symptomatic gastroesophageal reflux.  Radiology. 2002;  225 359-365
• 4 Do Y S, Choo S W, Suh S W. et al . Malignant esophagogastric junction obstruction: palliative treatment with an antireflux valve stent.  J Vasc Intervent Radiol. 2001;  12 647-651
• 5 Dua K S, Kozarek R, Kim J. et al . Self-expanding metal esophageal stent with anti-reflux mechanism.  Gastrointest Endosc. 2001;  53 603-613
• 6 Nunes C C, Waechter F L, Sampaio J A. et al . Comparative post-operative study of prostheses, with and without an anti-reflux valve system, in the palliative treatment of esophageal carcinoma.  Hepatogastroenterology. 1999;  46 2859-2864
• 7 Kocher M, Dlouhy M, Neoral C. et al . Esophageal stent with antireflux valve for tumors involving the cardia: work in progress.  J Vasc Intervent Radiol. 1998;  9 1007-1010
• 8 Bethge N, Vakil N. A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction.  Am J Gastroenterol. 2001;  96 1350-1354
• 9 Kang S G, Song H Y, Lim M K. et al . Esophageal rupture during balloon dilation of strictures of benign or malignant causes: prevalence and clinical importance.  Radiology. 1998;  209 741-746
• 10 Owen A, Laasch H-U, Marriott A. et al . Oesophageal stent follow-up: routine contrast swallow does not add to the management [abstract].  Cardiovasc Intervent Radiol. 2003;  26 197