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Gastrointestinal Endoscopy - part 3

Các biến chứng của endoprostheses thực quản Di cư Peforation Hơn / mọc vào trong thực phẩm impaction xuất huyết thủ tục tỷ lệ tử vong Tỷ lệ tử vong (30 ngày) | Malignant Esophagus 43 Table 6.5 Complications of esophageal endoprostheses Peforation Migration Over ingrowth Food impaction Hemorrhage Procedural mortality Mortality 30 day Pre- vs postoperative adjuvant chemoradiation High postop morbidity up to 75 Operative mortality 10 in experienced centers Most surgery in U.S. is palliative Radiation therapy External beam radiation Intraluminal radiation brachytherapy Curative by itself on occasion squamous cell adenocarcinoma Best responses in women proximal tumors and tumors 5 cm in length Complications include esophagitis stricture pneumonitis pulmonary fibrosis pericardial effusion transverse myelitis ERF Chemotherapy Cisplatin 5-fluorouracil 5-FU Paclitaxel Ineffective in achieving local tumor control or improving survival May have some benefit in metastatic disease control Combined chemoradiation Chemotherapy seems to potentiate the effects of radiation therapy Improved local disease control Dose and timing of each not established Morbidity increases with higher dose of either Severe side-effects in up to 40 Life-threatening side effects in up to 20 Improved survival if complete or partial responders as compared to non-re-sponders Endoscopic Management Endoscopic mucosectomy Limited to esophageal tumors involving the mucosa layer only Submucosal injection snare resection technique Suction device snare Curative resection in the majority of cases 92.5 5 yr survival Perforation rate 2-3 Photdynamic therapy PDT Intravenous administration of light-sensitive porphyrin derivative Accumulates preferentially in tumor cells Activation by low energy laser delivered via an endoscopic probe Photochemical reaction leads to cytotoxicity and tumor necrosis 6 44 Gastrointestinal Endoscopy 6 Table 6.6 Treatment options for esophageal cancer Treatment Advantages Disadvantages Surgical resection Potentially curative High morbidity high cost low cure rate Radiation therapy Potential complete response Improves local tumor control Moderate .