Skip to main content
Log in

Randomized comparison of endoscopic palliation of malignant esophageal stenoses

  • Original Articles
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Summary

In a randomized study, palliative therapy of malignant esophageal and gastric stenosis was investigated by a comparison of endoscopic laser therapy (ELT) with palliative endoscopic pertubation (PEP). A total of 124 patients exhibiting a malignant stenosis in the esophagus and proximal stomach were referred to our unit between January 1, 1987, and March 31, 1990. Criteria for randomization were: (1) inoperable malignant stenosis, (2) dysphagia enabling the ingestion of semi-solid food, (3) the possibility of performing ELT and PEP, and (4) the absence of fistula formation. Only 40 patients met these criteria; the remaining 84 subjects were assigned to an escape group whose treatment consisted of ELT, PEP, percutaneous endoscopic gastrostomy, transnasal feeding tube, radiotherapy, and endoscopic bougienage. We found no significant difference between ELT and PEP with regard to survival, food passage, or quality of life. We recommend the application of PEP in patients exhibiting advanced tumor disease and a poor general condition and favour the use of ELT combined with afterloading in patients with a life expectancy of ⩾3 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Atkinson M, Ferguson R (1977) Fiberoptic endoscopic palliative intubation of inoperable oesophagogastric neoplasms. Br Med J I: 266–267

    Google Scholar 

  2. Bader M, Dittler HJ, Ultsch B, Ries G, Siewert JR (1986) Palliative treatment of malignant stenoses of the upper gastrointestinal tract using a combination of laser and afterloading therapy. Endoscopy 18: 27–31

    Google Scholar 

  3. Buess G, Eitenmüller J, Hildebrand E (1983) Komplikationen durch Materialprobleme des endoskopisch gelegten Tubus bei Tumorstenosen des Ösophagus und des Magens. In: Richter H (ed) Chirurgische Endoskopie — Komplikationen bei Diagnostik und Therapie. Urban & Schwarzenberg, München, pp 76–79

    Google Scholar 

  4. Carter R, Smith J (1986) Oesophageal carcinoma: a comparative study of laser recanalization versus intubation in the palliation of gastro-oesophageal carcinoma. Lasers Med Sci 1: 245–251

    Google Scholar 

  5. Celestin LR (1959) Permanent intubation of inoperable cancer of the oesophagus and cardia. Ann R Coll Surg Engl 25: 165–170

    Google Scholar 

  6. DeMeester RR, Barlow AP (1988) Surgery and current management for cancer of the esophagus and cardia. In: Ravitch MM (ed) Current problems of surgery. Year Book Medical Publishers, Chicago, pp 580–587

    Google Scholar 

  7. Fleischer D, Sivak MV Jr (1985) Endoscopic Nd:YAG laser therapy as palliation for esophagogastric cancer. Gastroenterology 89: 827–831

    Google Scholar 

  8. Fleischer D, Haye O, Kessler F (1982) Endoscopic palliative therapy for esophageal carcinoma with the Nd-YAG laser. Gastrointest Endosc 28: 131–135

    Google Scholar 

  9. Frimberger E, Kühner W, Ottenjann R (1981) Neuer Tubus zur palliativen Therapie des stenosierenden Karzinoms im distalen Ösophagus. In: Häring R (ed) Chirurgie des Ösophaguskarzinoms. Edition Medizin, Weinheim, pp 311–317

    Google Scholar 

  10. Fuchs KH, Wirtz HJ, Bauer E, Hamelmann H (1984) Möglichkeiten und Grenzen der palliativen endoskopischen Pertubation. Zentralbl Chir 109: 1081–1086

    Google Scholar 

  11. Lux G, Groitl H, Ell C (1986) Tumor stenoses of the upper gastrointestinal tract — therapeutic alternatives to laser therapy. Endoscopy 18 [Suppl 1]: 37–43

    Google Scholar 

  12. Manegold BC (1979) Palliative Tumortherapie in der Endoskopie. In: Demling L (ed) Operative Endoskopie. Schattauer, Stuttgart, pp 219–226

    Google Scholar 

  13. Manegold BC (1990) Endoskopische Pertubation. In: Buess G (ed) Endoskopie — von der Diagnostik bis zur neuen Chirurgie. Deutscher Ärzte-Verlag, Köln, pp 171–178

    Google Scholar 

  14. Paolucci V, Henne T, Schmidt-Matthiesen A (1990) Endoskopischpalliative Tubus- und Laser-Therapie bei fortgeschrittenem Carcinom von Oesophagus und Kardia. Chirurg 61: 43–48

    Google Scholar 

  15. Sander R, Poesl H, Spuhler A (1985) Therapie gastrointestinaler Tumoren mit Laser. Internist 26: 22–28

    Google Scholar 

  16. Siewert JR, Dittler H-J (1990) Kommentar auf Anforderung der Schriftleitung zu: Endoskopisch-palliative Tubus- und Laser-Therapie bei fortgeschrittenem Carcinom von Oesophagus und Kardia von V. Palolucci, T. Henne und A. Schmidt-Matthiesen. Chirurg 61: 46–48

    Google Scholar 

  17. Tytgat GN (1980) Endoscopic methods of treatment of gastrointestinal and biliary stenoses. Endoscopy 12 [Suppl]: 57–61

    Google Scholar 

  18. Tytgat GNJ, Hartog Jager FCA den, Bartelsman JFWM (1986) Endoscopic prosthesis for advanced esophageal cancer. Endoscopy 18 [Suppl 3]: 32–39

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fuchs, KH., Freys, S.M., Schaube, H. et al. Randomized comparison of endoscopic palliation of malignant esophageal stenoses. Surg Endosc 5, 63–67 (1991). https://doi.org/10.1007/BF00316838

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00316838

Key words

Navigation