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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a group of 56 patients with inoperable carcinoma of the esophagus treated at the authors' department during the last five years the authors analyse the possibilities of palliative treatment of dysphagia. As a criterion of success they consider life-long restoration of comfortable swallowing achieved during short-term hospitalisation with rapid return of the patient to home care. In the authors' opinion none of the methods is universal. Therefore it is important that a patient with carcinoma of the esophagus should be treated in a department which is familiar with the whole range of the problem.
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PMID:[Palliative treatment of malignant dysphagia]. 876 64

Most patients with carcinoma of the esophagus present with progressive, unrelenting dysphagia, malnutrition, and weight loss. Palliation is the primary treatment, since these patients are not candidates for curative surgical resection. Surgery, radiotherapy, and endoscopic modalities have been used for palliation. Recently, self-expanding, metallic stents have been used with considerable success. This type of stent can dislodge into the stomach during or after deployment. We report an approach to retrieve an expandable, silicone-coated stent using a double-channel endoscope, an esophageal dilating balloon, and a polypectomy snare.
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PMID:Palliation of esophageal cancer with a self-expanding, silicone-covered stent and a technique for stent retrieval. 880 19

Two hundred and twenty-four patients with histologically-confirmed carcinoma of the oesophagus received palliative Nd-YAG laser therapy for malignant dysphagia between January 1986 and December 1994. The results are appraised in terms of the degree of relief obtained, its relation to the macroscopic type and the size of the tumour, peri-operative complications, duration of hospitalization and survival after treatment. Recannulation of the oesophageal lumen was obtained in 98.2% of the patients, after which 93.7% were able to ingest at least semi-solids. Although the lumen was permeable for a 9.8 mm endoscope, the remainder could only ingest liquids. The only complication was a perforation is six cases (2.7%). After treatment, 14.8% survived more than 1 year and 3.4% more than 2 years. After discussing the role of lasers in the palliative treatment of malignant dysphagia, the authors conclude that it can be considered effective in that it relieves the dysphagia and improves the patients' quality of life.
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PMID:Nd-YAG laser as a palliative treatment for malignant dysphagia. 884 72

Common late complications after esophagectomy and gastric tube reconstruction for esophageal carcinoma are symptomatic, benign fibrotic stenoses of the cervical anastomosis, which require dilatation. Since the prognosis of esophageal carcinoma still remains poor, bad functional results such as dysphagia affect quality of life. In a retrospective analysis, our patients were evaluated with regard to the underlying effects of cervical anastomotic stenosis after esophagectomy and gastric tube reconstruction. From 1 January 1989 to 31 July 1995, 173 patients with carcinoma of the esophagus were operated in our institution. Transhiatal esophageal dissection was performed in 133 patients; 40 patients underwent transthoracic en bloc resection. The 30-day mortality rate was 7.5% (13 patients). Postoperative fibrotic stenosis of the cervical anastomosis requiring dilatation occurred in 36.4% (63 patients) 6-12 weeks after operation. Fibrotic stenosis of the cervical anastomosis did not develop in 97 patients. There was a significant difference concerning the incidence of anastomotic leaks within both groups: whereas in 23.8% of the 63 patients who developed a fibrotic stricture of the cervical anastomosis an anastomotic leak preceded this event (P < 0.001), no anastomotic leak occurred in the group of 97 patients with normal healing of the cervical anastomosis. In addition, significantly (P < 0.01) more patients (37.5%, n = 23) with preexisting diabetes mellitus could be found among the 63 patients who developed a fibrotic stricture of the cervical anastomosis, in contrast to the 97 patients without anastomotic stenosis.
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PMID:[Cervical anastomotic stenosis after gastric tube reconstruction in esophageal carcinoma. Evaluation of a patient sample 1989-1995]. 932 13

This was a retrospective analysis of 177 histologically confirmed cases of oesophageal carcinoma seen in the University College Hospital, Ibadan, Nigeria over a period of 30 years. Oesophageal carcinoma constituted 0.6 per cent of all malignant neoplasms and 1.4 cases per 1000 surgical biopsies during the study period. Dysphagia and weight loss were the most common clinical manifestations. Ninety three patients presented within one year of onset of clinical symptoms. The peak age incidence occurred in the seventh decade of life. Sex distribution was equal. The middle third of the oesophagus was the most common location of the neoplasm and the vast majority (94.5%) were squamous cell carcinomas. Achalasia of the cardia and Barrett's oesophagus were not associated with oesophageal carcinoma in this study. Regional lymph nodes and lungs were the most common sites of metastasis. Surgical complications included mediastinitis and bronchopneumonia, both occurring within seven days postoperatively. Late clinical presentation and high postoperative mortality are responsible for the persistently poor prognosis of oesophageal carcinoma despite significant advances in the diagnosis and management of these neoplasms.
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PMID:Carcinoma of the oesophagus in Ibadan. 933 9

The outcome of 211 patients undergoing laser therapy as palliation for inoperable carcinoma of the esophagus is presented. The median age was 73 (range 44-97). The histology was adenocarcinoma for 127 patients and squamous-cell carcinoma for 84 patients. For 133 patients, laser was the only therapy while 56 patients had a combination of laser therapy and radiotherapy/chemotherapy. One patient underwent laser recanalization prior to resection while four patients had recurrence after resection treated by laser. Eleven patients underwent laser therapy for recurrent dysphagia after placement of an esophageal endoprosthesis. Eighteen patients died of procedure-related complications (i.e. 9% of patients and 2% of procedures). Of 32 procedures which perforated the tumour, 10 ended in death and the remaining patients were successfully treated conservatively. Good palliation was achieved for 170 patients (80%), while 19 patients underwent intubation after failure of laser therapy. Laser therapy failed to relieve dysphagia for 22 patients. The median survival was 20 weeks with the 1-year survival 12% and 2-year survival 4%; there were no significant differences in survival dependent on histology or administration of adjuvant radiotherapy or chemotherapy. Laser therapy provides a practical alternative to intubation in the treatment of malignant dysphagia for patients with unresectable esophageal carcinoma.
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PMID:Palliation of malignant dysphagia by laser therapy. 945 50

Patients with nonresectable gastrointestinal tumors have a life expectancy of a few months only. Effective palliative treatment has to ensure a good quality of life with minimal morbidity and mortality. Esophageal carcinoma: Endoscopic intubation or stent implantation guarantee a prompt improvement of dysphagia with minimal morbidity and mortality in esophageal carcinoma. Only in cervical or noncircumferential stenosis laser therapy is preferable. Obstructive jaundice: Metal stents offer the best quality of life after palliative treatment of malignant obstructive jaundice. However, in patients with bad general conditions and a short life expectancy a pigtail catheter is less expensive. Colorectal cancer: Laser therapy and cryosurgery offer uncomplicated nonsurgical therapy in rectal carcinoma. Stents in the colorectum have a high complication rate. Endoscopic palliative treatment of gastrointestinal tumors can be performed with minimal morbidity and mortality. However, it is essential that a surgeon is involved in the decisionmaking between endoscopic or operative treatment.
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PMID:[Endoscopic palliative treatment of tumors of the gastrointestinal tract]. 970 43

Most patients with carcinoma of the esophagus have advanced disease at presentation. Since cure is usually not possible, the goal of treatment is the palliation of dysphagia. Palliative modalities include bougies, balloons, stents, tumor probe, laser, surgery, chemotherapy, and radiation. In recent years, combined chemotherapy and radiation has shown promising results. However, the relief of dysphagia is slow and frequently incomplete. We compared the effectiveness of dilatation alone versus dilatation plus Nd-YAG laser therapy for the relief of dysphagia while assessing the role of chemotherapy and radiation as an adjunct to surgery. Fifteen patients with squamous cell carcinoma of esophagus who were deemed fit for intensive chemotherapy and radiation were randomized to receive either dilatation alone (N = 7) or dilatation plus laser (N = 8); the end-point for initial success was the passage of a 45 French Savary dilator, and the relief of dysphagia. At entry, 13 of these 15 patients were judged potentially resectable. However, after chemotherapy and radiation, only 3 of 13 (20%) patients could be offered surgery; the remainder were considered too poor a surgical risk. Follow-up was for 30 months, or until death. Further dilatations were performed as needed for relief of dysphagia. No difference was observed between the laser plus dilatation and the dilatation alone group with respect to the degree of dysphagia, weight record, quality of life index (Karnofsky score), or mortality rate. Our results indicate that in patients undergoing chemotherapy and radiation for esophageal carcinoma, dilatation alone provides adequate palliation of dysphagia, and in these patients, chemotherapy and radiation is a poor adjunct to surgical treatment.
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PMID:A randomized comparison of dilatation alone versus dilatation plus laser in patients receiving chemotherapy and external beam radiation for esophageal carcinoma. 979 Apr 62

Dysphagia is an important and distressing symptom which has a significant impact on the quality of life of patients with carcinoma of the esophagus. Although endoscopic palliation of dysphagia due to unresectable or recurrent esophageal carcinoma can be provided by esophageal dilatation and intubation, laser ablation, injection of alcohol or sclerosants, or brachytherapy, these techniques are often unsuitable for the palliation of high esophageal tumors. We present a patient with recurrent carcinoma of the proximal esophagus who developed an inability to swallow as a complication of intubation with an esophageal stent. The dysphagia improved dramatically after the stent was removed.
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PMID:Esophageal stents may interfere with the swallowing reflex: an illustrative case history. 980 53

We report an audit of two different telebrachytherapy schedules in inoperable carcinoma of the oesophagus. Between October 1990 and December 1996, 108 patients with a Karnofsky performance status > or = 50 were selected from our database on the basis of intention to treat by telebrachytherapy. Teletherapy in the low dose group L (55 patients) consisted of 35 Gy in 15 fractions over 3 weeks, while that in the high dose group H (53 patients) consisted of 50 Gy in 25 fractions over 5 weeks. The choice of teletherapy dose was based on physician preference. The high dose rate intraluminal radiotherapy that followed 2 weeks later was identical in both groups and consisted of two applications of 6 Gy, a week apart. The pretreatment disease characteristics of the patients in both arms were similar. Relief of dysphagia was obtained in 49% of the patients in group L and in 75% of those in group H (chi2: P = 0.004). The median dysphagia-free interval was 0 and 7 months in groups L and H respectively (log-rank: P = 0.06), while the median overall survival was identical at 8 months (log-rank: P = 0.21) for both groups. The probability of survival at 1, 2 and 5 years was 34.8% versus 35.8%, 14.5% versus 13.9% and 0% versus 10% for groups L and H respectively. Morbidity in the form of ulcers, strictures and fistulae were observed in 9%, 7% and 5% of patients in group L compared with 8%, 8% and 13% in groups H respectively. This audit suggests that the protocol used in group H, when compared with group L, results in a greater proportion of patients being rendered dysphagia free, with a statistical trend towards a greater sustainment of dysphagia relief on follow-up.
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PMID:A non-randomized comparison of two radiotherapy protocols in inoperable squamous cell carcinoma of the oesophagus. 984 31


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