Endoluminal palliation for dysphagia secondary to esophageal carcinoma

Abstract

There are now a variety of treatment options available to palliate dysphagia in patients with advanced esophageal carcinoma. The decision as to which therapy to recommend for a patient should be based on a though understanding of the therapies and must be individualized for each patient and on the experience of the endoscopist or surgeon. In addition, consideration should be given as to resource availability at a particular institution. External beam radiation currently has little role as primary treatment for dysphagia. Brachytherapy is labor intensive; requires 2 to 3 weekly treatments, highly specialized radiation equipment, and an experienced radiation oncologist; and is therefore limited to tertiary care centers. Endoluminal YAG-laser tumor ablation is feasible at many institutions and provides immediate dysphagia relief but has limited durability (weeks) if not followed by adjuvant therapy, and requires an endoscopist with significant laser experience. PDT is relatively easy to perform and has a lower perforation rate and longer durability than YAG laser therapy but it is relatively costly and less patient friendly due to the morbidity of its attendant 6 weeks of photosensitivity. Advances in stent technology have rendered this a safe, readily available treatment for the palliation of dysphagia. Palliation of dysphagia is an important but difficult goal that may require creative use of a variety of endoscopic interventions, either in combination or serially. Ideally, physicians who palliate dysphagia secondary to esophageal cancer should be facile in both endoscopic ablative and stenting techniques and have a close working relationship with both radiation and medical oncologists.