ABSTRACT
The treatment of upper gastrointestinal tract cancers continues to be a challenge to clinicians. Esophageal carcinoma and malignancies that cause gastric outlet or duodenal obstruction are particularly distressing to both the patient and clinician due to their frequent late stage of presentation as well as their adverse effects on quality of life. The incidence of esophageal adenocarcinoma has been increasing worldwide, while that of esophageal squamous cell carcinoma is decreasing.1,2 Moreover
11.1 Overview of Esophageal Carcinoma and Malignancies Responsible for Gastric Outlet Obstruction ...................................................................... 175
11.2 Methods of Palliation .................................................................................... 176 11.2.1 Esophageal Obstruction .................................................................... 176 11.2.2 Gastric Outlet and Duodenal Obstruction ........................................ 177
11.3 Stents and Characteristics ............................................................................. 177 11.4 Technical Considerations Regarding Placement .......................................... 182
11.4.1 Esophageal Obstruction .................................................................... 182 11.4.2 Gastric Outlet and Duodenal Obstruction ........................................ 184
11.5 Esophageal Obstruction Outcomes ............................................................... 185 11.6 Gastric Outlet and Duodenal Obstruction Outcomes ................................... 186 11.7 Poststent Care ............................................................................................... 186 11.8 Conclusions ................................................................................................... 187 References .............................................................................................................. 187
there has been a signicant increase in the proportion of patients presenting with Stage IV adenocarcinoma.3 Consequently, approximately 50 to 60% of patients have incurable disease at the time of presentation.4 Based on the histologic organization of the esophagus, squamous cell carcinoma typically occurs in the midesophagus, whereas adenocarcinoma typically occurs in the distal esophagus. Early esophageal carcinomas typically appear as supercial plaques or ulcerations while more advanced lesions can present as strictures or ulcerating and bleeding esophageal masses. Because this malignancy develops as an intraluminal lesion, the advanced stage malignancies most commonly cause symptoms of dysphagia or odynophagia. Other presentations include iron deciency anemia, overt gastrointestinal bleeding, or tracheoesophageal stula. In the subset of patients with late stage disease, therefore, palliative therapy is focused on relieving symptoms of dysphagia.
