Document Detail


Management of unresectable malignant esophageal obstruction.
MedLine Citation:
PMID:  1703646     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Malignant esophageal obstruction (MEO), especially with esophago-respiratory fistula (ERF), requires efforts to achieve a meaningful degree of palliation. Laser vaporization (LV) of the esophageal tumor and placement of an endoesophageal prosthesis (EEP) represents a new combination for palliation of MEO. The purpose of the present study was to evaluate the neodymium-yttrium-aluminum-garnet (Nd:Yag) laser in reopening the esophageal channel to permit both swallowing and insertion of an EEP. Twenty-three consecutive patients with MEO were evaluated, and ERF was documented by preoperative contrast study in eight patients. All 23 patients underwent laser vaporization, dilation, and surgical placement of EEP. Adequate swallowing was attained in 21 patients; one patient with an ERF experienced recurrent aspiration from failure of the EEP to occlude the fistulous tract. Operative morbidity was 17% (4/23), which included: wound infection, 2; persistence of ERF, 1; esophageal perforation, 1; and food impaction, 1. Thirty-day operative mortality was 9% (2/23). Palliation was excellent in 87% (20/23), with discharge from the hospital by the seventh postoperative day. Mean survival was 3.3 months. We conclude that laser vaporization followed by placement of an EEP represents a major advance in the palliation of MEO.
Authors:
L Wetstein; A Brenner
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Military medicine     Volume:  155     ISSN:  0026-4075     ISO Abbreviation:  Mil Med     Publication Date:  1990 Jul 
Date Detail:
Created Date:  1991-03-07     Completed Date:  1991-03-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  2984771R     Medline TA:  Mil Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  324-6     Citation Subset:  IM    
Affiliation:
Division of Thoracic Surgery, Medical College of Virginia, Richmond.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Carcinoma, Squamous Cell / complications,  surgery*
Clinical Protocols
Esophageal Fistula / etiology,  surgery
Esophageal Neoplasms / complications,  surgery*
Esophageal Stenosis / etiology,  surgery*
Evaluation Studies as Topic
Female
Humans
Laser Therapy / methods*
Male
Middle Aged
Palliative Care / methods
Prostheses and Implants
Grant Support
ID/Acronym/Agency:
I R23 HL34515-O1A1/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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