Routine chest radiography following endoscopic oesophageal dilatation for benign peptic oesophageal strictures

Endoscopic oesophageal dilatation is a well-established procedure for management of patients with benign oesophageal strictures. The most important complication of the procedure is perforation with a recorded incidence of approximately 1%. Patients undergoing the procedure require close observation after dilatation. Routine chest radiographs are advisable following the procedure.     

Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer

Self-expanding metal stent placement and single-dose brachytherapy are commonly used for the palliation of oesophageal obstruction due to inoperable oesophagogastric cancer. We randomised 209 patients to the placement of an Ultraflex stent (n=108) or single-dose brachytherapy (12 Gy, n=101). Cost comparisons included comprehensive data of hospital costs, diagnostic interventions and extramural care. We acquired detailed information on health care consumption from a case record form and from monthly home visits by a specialised nurse. The initial costs of stent placement were higher than the costs of brachytherapy (1500 euro vs 570 euro; P<0.001). Total medical costs were, however, similar (stent 11 195 euro vs brachytherapy 10 078 euro, P>0.20). Total hospital stay during follow-up was 11.5 days after stent placement vs 12.4 days after brachytherapy, which was responsible for the high intramural costs in both treatment groups (stent 6512 euro vs brachytherapy 7982 euro, P>0.20). Costs for medical procedures during follow-up were higher after stent placement (stent 249 euro vs brachytherapy 168 euro, P=0.002), while the costs of extramural care were similar (1278 euro vs 1046 euro, P>0.20). In conclusion, there are only small differences between the total medical costs of both palliative treatment modalities, despite the fact that the initial costs of stent placement are much higher than those of brachytherapy. Therefore, cost considerations should not play an important role in decision making on the appropriate palliative treatment strategy for patients with malignant dysphagia.     

国产食管金属内支架的临床应用

目的探讨国产食管金属内支架治疗食管癌性狭窄、食管—气管瘘及食管—纵隔瘘临床应用价值。方法先用导丝通过狭窄段,经球囊扩张,置入带膜食管金属内支架。结果48例食管狭窄者内支架置入后吞咽困难完全消除的7例（14．6％）,41例（85．4％）明显缓解。6例食管—气管瘘口封闭。结论国产食管金属内支架置入是治疗食管恶性狭窄安全可靠的方法,术后应继续进行抗癌治疗。     

Tracheo-oesophageal fistula after palliative treatment of oesophageal cancer

We present a case of an 86-year-old male who presented with severe pneumonia in the context of having undergone radiotherapy and then an oesophageal stent insertion for palliation of oesophageal cancer. He was diagnosed with a tracheo-oesophageal fistula (TOF) which was successfully managed by deploying a second stent within the first stent.     

Management of benign oesophageal strictures in children

Managing oesophageal strictures, whether benign or malignant has always been a challenging task for ENT Surgeons, Endoscopists, Cardio-thoracic surgeons and Gastro-enterologists. Although various newer technological developments have helped in better management of malignant strictures, it is the benign strictures that are still being managed by conventional means with gum-elastic bougies and other dilatation techniques. Children are not immune to benign strictures, rather corrosive strictures, congenital webs and membranes etc. are much more common in the paediatric age group. We present the technical details and our experience in managing benign oesophageal strictures in five children by endoscopic balloon dilatation.     

Incidental computed tomography diagnosis of a giant oesophageal leiomyosarcoma

Leiomyosarcoma of the oesophagus is a very unusual tumour; only 53 cases have been reported in the English-language literature. A case is reported here of a patient with a giant leiomyosarcoma, without any symptoms of dysphagia. The diagnosis was made incidentally during CT examination of the chest for detection of possible pulmonary metastases from a coexisting carcinoma of the bladder. This was confirmed by a barium swallow, oesophagoscopy and tissue diagnosis. The literature pertaining to this most uncommon tumour is reviewed.     

两种国产金属支架在治疗食管良恶性狭窄应用中的比较

目的:作者分析了63例食管内支架术的结果,旨在选择理想的金属支架.方法:本组63例食管良、恶性狭窄,使用2种支架材料,共安放69根,其中不锈钢支架19根、镍钛合金支架50根.结果:国产金属支架治疗食管良、恶性狭窄安全有效,又以镍钛合金被覆细腰喇叭形支架为最好,成功率高、副作用少.结论:镍钛合金支架优于不锈钢支架,在采用腔内支架治疗食管良、恶性狭窄中,应首选镍钛合金被覆细腰喇叭形支架.     

Brachytherapy in oesophageal carcinoma

Patients with recurrent or locally advanced oesophageal carcinoma have a poor prognosis. Relief of dysphagia is often the goal of any further treatment. Several methods, including laser re-canalization, prosthetic intubation, dilatation, external beam irradiation (EBI) and intraluminal brachytherapy (IBT) can be used to alleviate dysphagia. In this retrospective review of 11 patients, eight with recurrent tumour and three newly diagnosed patients were treated with low dose rate IBT. Relief of dysphagia was achieved in nine patients, all of whom were able to maintain swallowing of at least a semi-solid diet until death or last follow-up. Toxicity was minimal, but survival was poor, with a median survival of only 3 months. IBT presents several advantages over other palliative methods, especially in recurrent tumours where re-treatment with EBI is often difficult because of normal tissue tolerance. Low dose rate IBT takes only 1–2 days to deliver, is highly effective, has little morbidity and the palliation achieved is relatively durable.     

电化学和带膜镍钛合金支架双介入治疗晚期食管、贲门癌

目的探讨电化学疗法和带膜镍钛记忆合金支架双重介入治疗食管、贲门恶性狭窄的可能性。方法采用国产电化学治疗仪和铂金导管状电极与带膜镍钛合金支架相结合，杀灭肿瘤细胞、扩展狭窄管腔，解决晚期食管、贲门癌梗阻。结果治疗18例，缓解率100％。双重介入治疗后，按Stooler，分级0级12例，Ⅰ级6例。生存期2～20个月。结论电化学和带膜镍钛记忆合金支架双介入治疗法安全有效，创伤小，可作为一种有效的姑息治疗方法。     

扩张置管治疗癌性复杂性食管狭窄和瘘51例分析

 目的 探讨内镜下覆膜支架治疗癌性难治性食管狭窄和瘘的临床疗效。方法 选择失去手术机会的复杂性食管狭窄和（或）瘘的患者51例进行内镜下扩张及支架置入术，根据病情的不同情况选择不同的治疗方式，并观察治疗后1个月及1年的临床疗效。结果 经过治疗，全部患者症状得到缓解，生活质量提高，51例患者共放置支架66个，置管后狭窄处直径由（4.05±1.34）mm增至（13.03±3.99）mm（P＜0.01），吞咽困难由（3.29±0.44）级改善为（0.95±0.73）级（P＜0.01），食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100 %，78.38 %，1年失访共3例，复发共8例，经重复治疗缓解。6 个月、1，2，3年生存率分别为86.3 %，72.6 %，33.3 %，6.3 %。结论 内镜直视扩张置管治疗难治性食管狭窄和瘘，操作直观简便，定位准确，成功率较高，近、远期效果较好。     

First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic oesophageal cancer: a phase II study

This phase II study assessed the safety and efficacy of oxaliplatin and capecitabine in patients with advanced oesophageal cancer. Fifty-one eligible patients received oxaliplatin 130 mg m(-2) intravenously on day 1 and capecitabine 1000 mg m(-2) orally twice daily on days 1 to 14 in a 21-day treatment cycle as first-line treatment for advanced oesophageal cancer. Grade 3 neutropenia was seen in one patient and anaemia in another patient. No grade 4 haematological toxicities were observed. Grade 4 non-haematological toxicity (lethargy) occurred in one patient (2%). Grade 3 non-haematological toxicity was seen in 14 (27%) patients (vomiting and polyneuropathy (8%); nausea (6%); lethargy and hand-foot syndrome (4%); and anorexia, diarrhoea, and hyperbilirubinaemia (each in one patient)). In 22% of the patients, toxicity was the reason for stopping the treatment. The overall response rate was 39%. The median overall survival was 8 months; the 1-year survival rate was 26%. In the quality of life (QoL) analysis, the emotional well-being improved during treatment, but the physical functioning scores declined. The fatigue score on the symptom scales increased. Overall, the global QoL score did not change during treatment. In conclusion, the activity of oxaliplatin and capecitabine is comparable with other chemotherapy regimens in advanced oesophageal cancer with a low frequency of grade 3/4 toxicity. Because this treatment can be given on an outpatient basis, it is probably less toxic than cisplatin-based therapy and preserves QoL during treatment, it is a viable treatment option in patients with advanced oesophageal cancer.     

Primary small-cell carcinoma of the oesophagus with spontaneous oesophageal perforation following chemotherapy

The authors describe a 66 year old woman with small-cell carcinoma of the oesophagus who developed a perforation following chemotherapy. Small-cell carcinoma of the oesophagus is a rare neoplasm, varying in appearance from a small mucosal lesion to a larger fungating mass, which in our patient presented as a bulky soft-tissue mass causing stricture. Pleural fluid collections which developed via a spontaneous oesophageal-pleural fistula were subsequently drained using percutaneously placed catheters. Radiologic management of this condition provided a successful and cost-effective means of patient care.     

Use of endoscopic mucosal clips in radiotherapy planning for oesophageal carcinoma: A series of three cases

This paper describes the technique of placing endoscopic mucosal clips to localize oesophageal carcinoma and hence facilitate radiotherapy planning. This technique has been used on three patients in our centre. One was treated radically with external beam radiotherapy and two were treated palliatively (retreatment) with intraluminal brachytherapy. Mucosal hemoclips were placed at the time of endoscopy to indicate the superior and inferior extent of the tumour. The clips provided a radiologically‐recognisable marker of the tumour extent and were visible on simulation films or planning CT scans. The radiation portal included the tumour as demarcated by the clips with an adequate margin. There were no complications related to the placement of the clips. All patients completed the radiotherapy course as planned.     

Definitive chemoradiation for oesophageal cancer--a standard of care in patients with non-metastatic oesophageal cancer

Aims

A retrospective analysis was carried out of 291 cases of oesophageal cancer treated with definitive chemoradiotherapy (dCRT) at a single UK cancer centre between 1995 and 2009. Our protocol consisted of two cycles of neoadjuvant platinum-based chemotherapy followed by two further cycles given concurrently with 50 Gy of external beam radiotherapy delivered in 25 fractions over 5 weeks.

Materials and methods

Demographic, patient and outcome data were recorded prospectively through an electronic health record and retrospectively analysed, using appropriate statistical tools.

Results

Data on 266 patients were available for analysis. The median age was 66.6 years, 53% were adenocarcinomas. dCRT was used instead of surgery because of age/co-morbidity in 44% and disease extent in 39%. Ninety-three per cent of patients completed treatment according to protocol. Grade 3 and 4 toxicities were seen in 42 and 7%, respectively. Median survival was 20.6 months; 2, 3 and 5 year survival rates were 43.6, 32.9 and 19.5%, respectively. Advanced disease was associated with a worse outcome. Shorter disease length was associated with a better median survival, but some patients with disease >10 cm had long-term disease control. The effect of other patient- and disease-related factors was also analysed.

Conclusion

We present data showing that dCRT is well tolerated and should be considered as an alternative to surgery for all patients with locally advanced oesophageal cancer, not only those with co-morbidity. Furthermore, the benefits of dCRT are not confined to carcinomas with squamous histology.     

The contribution of smoking and smokeless tobacco to oesophageal squamous cell carcinoma risk in the African oesophageal cancer corridor: Results from the ESCCAPE multicentre case-control studies

Tobacco use is a well-established risk factor for oesophageal squamous cell carcinoma (ESCC) but the extent of its contribution to the disease burden in the African oesophageal cancer corridor has not been comprehensively elucidated, including by type of tobacco use. We investigated the contribution of tobacco use (smoking and smokeless) to ESCC in Tanzania, Malawi and Kenya. Hospital-based ESCC case-control studies were conducted in the three countries. Incident cases and controls were interviewed using a comprehensive questionnaire which included questions on tobacco smoking and smokeless tobacco use. Logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of ESCC associated with tobacco, adjusted for age, sex, alcohol use, religion, education and area of residence. One thousand two hundred seventy-nine cases and 1345 controls were recruited between August 5, 2013, and May 24, 2020. Ever-tobacco use was associated with increased ESCC risk in all countries: Tanzania (OR 3.09, 95%CI 1.83-5.23), and in Malawi (OR 2.45, 95%CI 1.80-3.33) and lesser in Kenya (OR 1.37, 95%CI 0.94-2.00). Exclusive smokeless tobacco use was positively associated with ESCC risk, in Tanzania, Malawi and Kenya combined (OR 1.92, 95%CI 1.26-2.92). ESCC risk increased with tobacco smoking intensity and duration of smoking. Tobacco use is an important risk factor of ESCC in Tanzania, Malawi and Kenya. Our study provides evidence that smoking and smokeless tobacco cessation are imperative in reducing ESCC risk.     

Percutaneous cystic duct stent placement in the treatment of acute cholecystitis

Percutaneous cholecystostomy is well established as a temporising treatment option in selected patients presenting with acute cholecystitis. However, some patients who undergo cholecystostomy will have persistent discharge, which precludes catheter removal, or may not be medically suitable for future cholecystectomy. In these circumstances, percutaneous cystic duct stenting isa novel treatment option. It may delay or avoid the need for cholecystectomy, and thereby provide definitive treatment in a subset of patients who have acute cholecystitis and a high anaesthetic risk or limited life expectancy. Current application has been limited largely to patients with pre-existing malignant common bile duct strictures, but there is potential for the application to be broadened to include other subsets of patients. In this paper, we describe the technique used for percutaneous cystic duct stenting in a patient and report on its effectiveness. We also explore the technical considerations and consider the application of the procedure on other groups of patients.     

食管支架置入术治疗食管恶性狭窄及食管气管瘘46例疗效分析

目的:探讨食管支架置入术治疗食管癌引起的食管狭窄及食管气管瘘的临床效果。方法:对46 例确诊为食管癌所致的恶性狭窄及食管气管瘘患者行食管支架置入,术后行影像学随访,评价其疗效。结果:46 例患者共置入 49 枚食管支架材料,均 1 次性成功置入。术后患者吞咽梗阻、呛咳缓解或消失,进食明显改善,未出现严重并发症。结论:支架置入治疗食管癌引起的食管狭窄以及食管气管瘘近期效果良好。     

胸骨后良性甲状腺肿瘤19例的外科治疗

目的：探讨胸骨后良性甲状腺肿瘤的手术治疗方式。方法：1996年1月－1999年12月本院头颈外科收治胸骨后良性甲状腺瘤的病人19例。均采用颈部入路方式的手术治疗,其中3例行锁骨头切除。结果：甲状腺腺瘤3例;结节性甲状腺肿16例。除1例有术后声音嘶哑外,无其他的并发症。结论：由颈部入路行胸骨后良性甲状腺肿瘤手术是安全的。     

Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer

AimsPatients with oesophageal cancer undergoing chemoradiation with curative intent are at high risk of malnutrition and its complications, including increased side effects of treatment. We have developed a nutrition pathway (NP), involving the early then periodic nutrition assessment of all patients presenting to the multidisciplinary oesophageal clinic who were planned to receive definitive chemoradiation.Materials and methodsPatients were assessed as at ‘low’, ‘moderate’ or ‘severe’ nutrition risk, and were provided with appropriate nutrition intervention ranging from preventative advice (low risk), oral nutrition support (moderate risk) to enteral feeding (severe risk). Outcomes for 24 patients treated before implementation of the NP were compared with those of 24 patients treated using the NP.ResultsPatients managed using the NP experienced less weight loss (mean weight change −4.2 kg ±6.4 cf. −8.9 kg ±5.9, P = 0.03), greater radiotherapy completion rates (92% cf. 50%, P = 0.001), fewer patients had an unplanned hospital admission (46% cf. 75%, P = 0.04), and those that did had a shorter length of stay (3.2 days ±5.4 cf. 13.5 days ±14.1, P = 0.002).ConclusionEarly and regular nutrition assessment/intervention and a multidisciplinary approach to nutrition care results in improved treatment tolerance for patients with oesophageal cancer receiving chemoradiation.