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Endoscopy 2002; 34(2): 139-145
DOI: 10.1055/s-2002-19858
State of the Art Review

© Georg Thieme Verlag Stuttgart · New York

Treatment of Oesophago-Gastric Tumours

K.  Leiper2-1 , A.  I.  Morris2-1
  • 1Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom
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Publication Date:
14 August 2002 (online)

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The incidence of oesophageal adenocarcinoma continues to rise rapidly in the West whereas cancer of the stomach is becoming less common. Most patients present with advanced disease that is not amenable to curative treatment. This review focuses on recent evidence on the endoscopic therapy of oesophago-gastric cancer. Although there are many treatment modalities available, there is a paucity of good quality randomised trial evidence on which to base palliative treatment decisions. Furthermore, although palliation of dysphagia may be improved by expandable metal stents or ablative therapy, there is no evidence that this improves survival and each of these therapies has a high frequency of complications particularly in longterm survivors. Exciting developments have however been reported in the therapy of early stage oesophago-gastric cancer. Endoscopic mucosal resection is particularly promising with high rates of complete removal of early cancer or high grade dysplasia. Long-term follow up of these patients is required because of high rates of metachronous tumour formation and at present there are no randomised trial data comparing endoscopic mucosal resection with conventional surgery.

References

  • 1 Kocher H M, Linklater K, Patel S. et al . Epidemiological study of oesophageal and gastric cancer in south-east England.  Br J Surg. 2001;  88 1249-1257
    CrossrefPubMedGoogle Scholar
  • 2 Wong R, Malthaner R. Esophageal cancer: a systematic review.  Curr Probl Cancer. 2000;  24 297-373
    PubMedGoogle Scholar
  • 3 Spehler S J. Disputing Dysplasia.  Gastroenterology. 2001;  120 1864-1868
    PubMedGoogle Scholar
  • 4 Shim C S. Endoscopic mucosal resection: an overview of the value of different techniques.  Endoscopy. 2001;  33 271-275
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Narahara H, Iishi H, Tatsuta M. et al . Effectiveness of endoscopic mucosal resection with submucosal saline injection technique for superficial squamous carcinomas of the esophagus.  Gastrointest Endosc. 2000;  52 730-734
    CrossrefPubMedGoogle Scholar
  • 6 Nomura T, Boku N, Ohtsu A. et al . Recurrence after endoscopic mucosal resection for superficial esophageal cancer.  Endoscopy. 2000;  32 277-280
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Shimizu Y, Tukagoshi H, Fujita M. et al . Metachronous squamous cell carcinoma of the esophagus arising after endoscopic mucosal resection.  Gastrointest Endosc. 2001;  54 190-194
    CrossrefPubMedGoogle Scholar
  • 8 Ell C, May A, Gossner L. et al . Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.  Gastroenterology. 2000;  118 670-7
    CrossrefPubMedGoogle Scholar
  • 9 Fujita H, Sueyoshi S, Yamana H. et al . Optimum treatment strategy for superficial esophageal cancer: endoscopic mucosal resection versus radical esophagectomy.  World J Surg. 2001;  25 424-431
    CrossrefPubMedGoogle Scholar
  • 10 Ono H, Kondo H, Gotoda t. et al . Endoscopic mucosal resection for treatment of early gastic cancer.  Gut. 2000;  48 225-229
    PubMedGoogle Scholar
  • 11 Miyata M, Yokoyama Y, Okoyama N. et al . What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions.  Endoscopy. 2000;  32 773-778
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Ninomiya Y, Yanagisawa A, Kato Y. et al . Unrecognizable intramucosal spread of diffuse-type mucosal gastric carcinomas of less than 20 mm in size.  Endoscopy. 2000;  32 604-608
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Ackroyd R, Brown N J, Davis M F. et al . Photodynamic therapy for dysplastic Barrett's oesophagus: a prospective, double blind, randomised, placebo controlled trial.  Gut. 2000;  47 612-617
    CrossrefPubMedGoogle Scholar
  • 14 Panjehpour M, Overholt B F, Haydek J M. et al . Results of photodynamic therapy for ablation of dysplasia and early cancer in Barrett's esophagus and effect of oral steroids on stricture formation.  Am J Gastroenterol. 2000;  95 2177-2184
    CrossrefPubMedGoogle Scholar
  • 15 Malhi-Chowla N, Wolfsen H C, DeVault K R. Esophageal dysmotility in patients undergoing photodynamic therapy.  Mayo Clin Proc. 2001;  76 987-989
    PubMedGoogle Scholar
  • 16 Krishnadath K K, Wang K K, Taniguchi K. et al . Persistent genetic abnormalities in Barrett's esophagus after photodynamic therapy.  Gastroenterology. 2000;  119 624-630
    CrossrefPubMedGoogle Scholar
  • 17 van Laethem J L, Jagodzinski R, Peny M O. et al . Argon plasma coagulation in the treatment of Barrett's high-grade dysplasia and in situ adenocarcinoma.  Endoscopy. 2001;  33 257-261
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Shand A, Dallal H, Palmer K. et al . Adenocarcinoma arising in columnar lined oesophagus following treatment with argon plasma coagulation.  Gut. 2001;  48 580-581
    CrossrefPubMedGoogle Scholar
  • 19 van Laethem J L, Peny M O, Salmon I J. et al . Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett's oesophagus.  Gut. 2000;  46 574-577
    CrossrefPubMedGoogle Scholar
  • 20 Gossner L, May A, Stolte M. et al . KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett's esophagus.  Gastrointest Endosc. 1999;  49 122-125
    PubMedGoogle Scholar
  • 21 Siersema P D, Hop W C, van Blankenstein M. et al . A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomised study.  Gastrointest Endosc. 2001;  54 269-272
    CrossrefPubMedGoogle Scholar
  • 22 Vakil N, Morris A I, Marcon N. et al . A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction.  Am J Gastroenterol. 2001;  96 1791-1796
    CrossrefPubMedGoogle Scholar
  • 23 Christie N A, Buenaventura P O, Fernando H C. et al . Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up.  Ann Thorac Surg. 2001;  71 1797-1801
    CrossrefPubMedGoogle Scholar
  • 24 Macdonald S, Edwards R D, Moss J G. Patient tolerance of cervical esophageal metallic stents.  J Vasc Interv Radiol. 2000;  11 891-898
    PubMedGoogle Scholar
  • 25 Wang M Q, Sze D Y, Wang Z P. et al . Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas.  J Vasc Interv Radiol. 2001;  12 465-474
    CrossrefPubMedGoogle Scholar
  • 26 Mosca F, Stracqualursi A, Portale T R. et al . Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation.  Dis Esophagus. 2000;  13 301-304
    CrossrefPubMedGoogle Scholar
  • 27 Mayoral W, Fleischer D, Salcedo J. et al . Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer.  Gastrointest Endosc. 2000;  51 556-559
    CrossrefPubMedGoogle Scholar
  • 28 Bartelsman J F, Bruno M J, Jensema A J. et al . Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients.  Gastrointest Endosc. 2000;  51 134-138
    CrossrefPubMedGoogle Scholar
  • 29 Golder M, Tekkis P P, Kennedy C. et al . Chest pain following oesophageal stenting for malignant dysphagia.  Clin Radiol. 2001;  56 202-205
    CrossrefPubMedGoogle Scholar
  • 30 McManus K, Khan I, McGuigan J. Self-expanding oesophageal stents: strategies for reintervention.  Endoscopy. 2001;  33 601-604
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Shim C S, Cho Y D, Moon J H. et al . Fixation of a modified covered esophageal stent: its clinical usefulness for preventing stent migration.  Endoscopy. 2001;  33 843-848
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 de Palma G D, Iovino P, Catanzano C. Distally migrated esophageal self-expanding metal stents: wait and see or remove?.  Gastrointest Endosc. 2001;  53 96-98
    CrossrefPubMedGoogle Scholar
  • 33 Siersema P D, Hop W C, van Blankenstein M. et al . A new design metal stent (Flamingo stent) for palliation of malignant dysphagia: a prospective study. The Rotterdam Esophageal Tumor Study Group.  Gastrointest Endosc. 2000;  51 139-145
    PubMedGoogle Scholar
  • 34 Poyanli A, Sencer S, Rozanes I. et al . Palliative treatment of inoperable malignant esophageal strictures with conically shaped covered self-expanding stents.  Acta Radiol. 2001;  42 166-171
    PubMedGoogle Scholar
  • 35 Dua K S, Kozarek R, Kim J. et al . Self-expanding metal esophageal stent with anti-reflux mechanism.  Gastrointest Endosc. 2001;  53 603-613
    CrossrefPubMedGoogle Scholar
  • 36 Freudenberg S, Hartel M, Fernandez F. et al . Thermoplastic stents: a new concept for endoluminal prosthesis.  Endoscopy. 2000;  32 49-53
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Ramanaden D N, Crimmins R, Smith P M. Atkinson tubes are a good cost-effective means of palliating inoperable oesophageal malignant strictures: an eight-year experience.  Eur J Gastroenterol Hepatol. 2000;  12 751-753
    PubMedGoogle Scholar
  • 38 Birch J F, White S A, Berry D P. et al . A cost-benefit comparison of self-expanding metal stents and Atkinson tubes for the palliation of obstructing esophageal tumors.  Dis Esophagus. 1998;  11 172-176
    PubMedGoogle Scholar
  • 39 Siersema P D, Hop W C, Dees J. et al . Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: a controlled, prospective study.  Gastrointest Endosc. 1998;  47 113-120
    CrossrefPubMedGoogle Scholar
  • 40 Maydeo A P, Bapaye A, Desai P N. et al . Endoscopic placement of indigenous plastic esophageal endoprostheses - does it still have a role in the era of expandable metallic stents? A prospective Indian study in 265 consecutive patients.  Endoscopy. 1998;  30 532-537
    PubMedGoogle Scholar
  • 41 White R E, Mungatana C, Topazian M. Esophageal stent placement without fluoroscopy.  Gastrointest Endosc. 2001;  53 348-351
    CrossrefPubMedGoogle Scholar
  • 42 Maier A, Anegg U, Tomaselli F. et al . Does hyperbaric oxygen enhance the effect of photodynamic therapy in patients with advanced esophageal carcinoma? A clinical pilot study.  Endoscopy. 2000;  32 42-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Maier A, Tomaselli F, Anegg U. et al . Combined photodynamic therapy and hyperbaric oxygenation in carcinoma of the esophagus and the esophago-gastric junction.  Eur J Cardiothorac Surg. 2000;  18 649-654
    CrossrefPubMedGoogle Scholar
  • 44 Maier A, Tomaselli F, Matzi V. et al . Photosensitization with hematoporphyrin derivative compared to 5-aminolaevulinic acid for photodynamic therapy of esophageal carcinoma.  Ann Thorac Surg. 2001;  72 1136-1140
    CrossrefPubMedGoogle Scholar
  • 45 Luketich J D, Christie N A, Buenaventura P O. et al . Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period.  Surg Endosc. 2000;  14 653-657
    CrossrefPubMedGoogle Scholar
  • 46 Maier A, Tomaselli F, Gebhard F. et al . Palliation of advanced esophageal carcinoma by photodynamic therapy and irradiation.  Ann Thorac Surg. 2000;  69 1006-1009
    CrossrefPubMedGoogle Scholar
  • 47 Carazzone A, Bonavina L, Segalin A. et al . Endoscopic palliation of oesophageal cancer: results of a prospective comparison of Nd:YAG laser and ethanol injection.  Eur J Surg. 1999;  165 351-356
    CrossrefPubMedGoogle Scholar
  • 48 Gossner L, Ell C. Malignant strictures. Thermal treatment.  Gastrointest Endosc Clin N Am. 1998;  8 493-501
    PubMedGoogle Scholar
  • 49 Akhtar K, Byrne J P, Bancewicz J. et al . Argon beam plasma coagulation in the management of cancers of the esophagus and stomach.  Surg Endosc. 2000;  14 1127-1130
    CrossrefPubMedGoogle Scholar
  • 50 Heindorff H, Wojdemann M, Bisgaard T. et al . Endoscopic palliation of inoperable cancer of the oesophagus or cardia by argon electrocoagulation.  Scand J Gastroenterol. 1998;  33 21-23
    PubMedGoogle Scholar
  • 51 Monga S P, Wadleigh R, Sharma A. et al . Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer.  Am J Clin Oncol. 2000;  23 86-92
    PubMedGoogle Scholar
  • 52 Konigsrainer A, Riedmann B, de Vries A. et al . Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: a prospective randomized trial.  Hepatogastroenterology. 2000;  47 724-727
    PubMedGoogle Scholar
  • 53 Anand B S, Saeed Z A, Michaletz P A. A randomized comparison of dilatation alone versus dilatation plus laser in patients receiving chemotherapy and external beam radiation for esophageal carcinoma.  Dig Dis Sci. 1998;  43 2255-2260
    CrossrefPubMedGoogle Scholar
  • 54 Nomori H, Horio H, Imazu Y. et al . Double stenting for esophageal and tracheobronchial stenoses.  Ann Thorac Surg. 2000;  70 1803-1807
    CrossrefPubMedGoogle Scholar
  • 55 Mauro M A, Koehler R E, Baron T H. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.  Radiology. 2000;  215 659-669
    CrossrefPubMedGoogle Scholar

Dr. Keith Leiper

Department of Medicine · University of Liverpool

Daulby Street · Liverpool · L69 3GA · United Kingdom

Fax: + 44-151-706-5802

Email: kleiper@liverpool.ac.uk

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