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Endoscopic palliative therapy of advanced esophageal cancer

Authors

Gf Donatelli, B Dallemagne, S Perretta, J Marescaux

Abstract

Esophageal cancer is a dramatic condition. 16,640 new cases and 14,500 deaths were estimated in the United States in 2010. This video shows the usefulness of interventional endoscopy for palliation of symptoms.

Keywords

Endoscopic palliative therapy, advanced esophageal cancer

Media type

Duration

03'47''

Publication

2011-07

Popular

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Audio

E-publication

WeBSurg.com, Jul 2011;11(07).
URL: http://www.websurg.com/doi-vd01en3349.htm

Endoscopic palliative therapy of advanced esophageal cancer

1. Introduction 00'18''

A 48-year-old man was referred to our department for complete dysphagia despite chemoradiotherapy for adenocarcinoma of the esophagogastric junction. A radiological esophagogram was carried out and confirmed the complete blockage of passage of contrast medium in the stomach.

2. Lesion finding 00'37''

With the patient under general anesthesia and in supine position, an upper endoscopy was performed using a standard single-channel endoscope. At the level of the gastro-esophageal junction, an ulcerated neoplastic obstructing mass causing complete occlusion of the lumen was visualized.

3. Introduction of double channel catheter 00'55''

A 7 French double-channel catheter was introduced through a very small passage identified on one side, and some contrast medium was injected. A very fine passage to the stomach was visualized. Attempts to pass the catheter were made but it could not be passed because of a very tight stenosis.

4. Guidewire insertion 01'13''

A standard 4-meter guidewire was then inserted into the other channel of the catheter and was gently passed in the stomach. To make sure that no false trajectory was made in the neoplastic mass or in the gastric wall, some more contrast medium was injected and the images were checked for any extraluminal leak.

5. Dilatation using endoscopic balloon 01'32''

The decision was made to dilate the stenosis in order to obtain a lumen of at least 8mm (24 French) for the placement of a Self-Expandable Metallic Stent (SEMS). The catheter was withdrawn while carefully holding the guidewire in place. An esophageal dilatation balloon was inserted. A 15mm diameter dilatation was achieved by applying a pressure of 6mmHg for one minute. The scope was slowly pushed over the balloon down to the stomach. Gastroscopy was carried out and the presence of a Sievert type 2 tumor was confirmed at the esophagogastric junction in retroversion. A Savary guidewire was positioned in the duodenum. The scope was withdrawn and the Savary guidewire was left in place. Under fluoroscopy guidance, marks were placed on the skin of the patient’s chest to delimit the distal and proximal tumor margins. A fully covered SEMS with an anti-reflux valve, 12cm long and 22mm in diameter, was advanced over the guidewire and slowly deployed under continuous fluoroscopy guidance into the appropriate position. Both the good position of the SEMS anchored in the stenosis and the dilatation were confirmed by the upper GI contrast study and the fluoroscopy. The patient started oral diet on the same day and he was discharged on the following day on a full diet. He was symptom-free at one-month follow-up.

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