Palliation of esophagogastric neoplasms

1. Gastroepato
2. Oncology
3. Palliation of esophagogastric neoplasm
4. Cancer of the esophagus
5. Vomiting
6. Oral cancer
7. Dysplasia of the oral cavity
8. Cancer of the esophagus
9. Gastric cancer, causes and signs

Notes bydr Claudio Italiano

Simptoms

If you read this page because you have problems with swallowing or chest or burning pain, go to your doctor immediately and talk about it.
The prognosis of patients with esophagogastric neoplasia is generally poor, with only 5% survival at 6 years. In most patients, no cure is possible at the time of diagnosis. The symptoms of esophagus cancer are:
Dysphagia, ie the patient feels that the food is blocked behind the breastbone and unconsciously brings the fist on the breastbone, beats it, or uses a glass of water with every sip, in order to slide the swallowed bolus into the stomach ;
Regurgitation, the patient that is regurgitating everything that has gobbled up; the regurgitation is not the vomit, but the return in pharynx of how much swallowed;
Reflex hypersalivation is a reaction of the organism to dysphagia;

Cough incessant if in the meantime tracheobronchial fistulas are created which are the last signs of the disease. The writer has had more cases of patients with dysphagia, of which the last was an 80-year-old patient who had referred to me complaining of a retrosternal burning and excessive salivation, which had proved to be a stenosing cancer of the esophagogastroduodenoscopy. second portion of the esophagus. The patient did not know what was affected, since the family members had denied us to inform him of the thing, so, quietly, he had started towards the natural path of his pathology, where a first prosthesis had been applied to his esophagus and, subsequently , six months later, due to a recovery of illness upstream, slipped a second prosthesis on the first; the prosthetic perpendicular positioning maneuvers were performed by dr. Tonino Borruto of the Division of Oncological Gastroenterology with whom I have the honor to cooperate. But returning to our topic, we will say that, in fact, one of the main targets in the treatment of cancer of the esophagus, given the outcome of the infamous injury of the lesion, it is preferable to avoid suffering if these are not indicated; I intend to refer to surgical therapy, radiotherapy or chemotherapy where they do not find any indication of fate. The ideal palliative technique should in these cases be painless, long-lasting, inexpensive, safe and should only require a short hospitalization.

Indications

The placement of an endoprosthesis is indicated when dilatation becomes ineffective or too difficult for the patient and the physician; another indication is the bronchoesophageal fistula which is incessant cause of coughing and aspiration of material, including pneumonia ab ingetsis.

Contraindications

The contraindications include the location of the cancer in the first 2 cm below the upper esophageal sphincter, a short life expectancy, except the case of patients, in fact, with fistula. Other contraindications are:
Total lumen obstruction that prevents the passage of a guide wire
Proliferation of non-circumferential tumor that prevents the appropriate anchorage of the prosthesis
Excessively soft or necrotic lesions
Profusely bleeding lesions
Almost horizontal orientation of the lumen
Difficulty in dilatation 

Treatment

Firstly, on the stenosing lesion of the instruments called dilators, for example that of Savary-Gilliardi and the metal olives of Eder-Puestow, are used. Sometimes balloon dilation is preferred for convenience.

Types of stent

The prostheses are like tubes, which are shaped for example that of polyvinyl (Tygon), with an outer diameter of 15.7 mm and an interior of 12.5 and a thickness of 1.6 mm, the prosthesis should be more than 5-6 cm longer than the wound. The proximal end of the prosthesis is precisely shaped as a funnel, heating it to 100 ° C and spreading it with a glass tube.

Other stents are:
  
Wilson-Cook made of silicone reinforced with metal spiral
Keymed -Atkinson, a radiopaque silicone rubber tube with nylon spiral cover
ESKA-Buess of silicone
The Medoc-Cèlestin tube made of latex with nylon spiral
Self-expanding metal prostheses:
The Wallstent and the Granturco prosthesis that resemble giant mollomes made of antioxidant, self-expanding and flexible alloy that are kept compressed inside a cylindrical membrane, which is withdrawn during positioning.

In any case, the patient is evaluated before proceeding with positioning, for cardiac activity, respiratory problems, kyphoscoliosis, etc.
It proceeds by dilating all the neoplasms under endoscopic / fluoroscopic control and, if it is possible to pass the lesion with a small endoscope, it is easier to position a guide wire that will act as a sort of "track" on which to slide the instrument avoiding the risk of take it blindly blindly and peel the already damaged esophagus with serious injury to the patient. This is done by placing dilators in increasing caliber. Then the prosthesis is made to slide, using a pusher-prosthesis tube, always under fluoroscopic control. The metal prostheses do not need this practice, that is the dilatation, because they are introduced closed, as if it were a thread with a sheath that, once located at the right point the prosthesis, is removed to allow the expansion of the spring. It is clear that this type of prosthesis is unlikely to be withdrawn.

Complications

The perforation of the esophagus already affected by the necrotized neoplastic lesion
The dislocation of the prosthesis that can migrate into the stomach
Growth of the tumor above the prosthesis
Stenosis due to reflux esophagitis when the tumor is at the esophagus-gastric junction
The clogging of the prosthesis (our patient dreamed of eating the strangest things, including the Baccalà alla Messinese (stock fish)!, for which he made the best cases to make him drink the famous Coca cola that has therapeutic actions of "unlocking" !! )

You can see also: