Kim Jin Hyoung, Song Ho-Young, Shin Ji Hoon, Kim Tae Won, Kim Kyung Rae, Kim Sung-Bae, Park Seung-Il, Kim Jong Hoon, Choi Eugene
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
J Vasc Interv Radiol. 2008 Jun;19(6):912-7. doi: 10.1016/j.jvir.2008.02.020. Epub 2008 Apr 18.
To prospectively evaluate an algorithm for palliative treatment of unresectable esophagogastric junction tumors based on stricture length.
Eighty-six patients with malignant esophagogastric obstructions were referred to the interventional radiology department for balloon dilation or stent placement due to dysphagia. Balloon dilation was performed in patients (n = 39) with a short segmental (< or =4 cm) stricture, whereas stent placement was performed in patients (n = 47) with a long segmental (>4 cm) stricture. In the balloon group, 16 patients with esophageal carcinoma underwent both chemotherapy and radiation therapy, whereas 23 patients with gastric carcinoma underwent only chemotherapy.
Technical success was achieved in all procedures in all patients (100%). The overall clinical success rate of balloon dilation and stent placement for a malignant esophagogastric junction was 87% (75 of 86 patients). Clinical success was achieved in 29 of the 39 patients in the balloon group (74%) and 98% (46 of the 47 patients in the stent group (98%). The overall complication rate was 21% (18 of 86 patients). Seventeen complications, which consisted of reflux (n = 8), migration (n = 6), tumor overgrowth (n = 2), and tissue hyperplasia (n = 1), occurred after stent placement, whereas one complication (intramural rupture) occurred after balloon dilation. The median symptom-free and survival periods were 120 (95% confidence interval: 114, 263) and 147 (95% confidence interval: 98, 196) days, respectively.
The treatment strategies seem to be reasonable for palliative therapy in patients with malignant esophagogastric junction obstructions. However, further investigations are needed to minimize the drawbacks of the methods and to determine optimal treatments in patients with unresectable malignant esophagogastric junction obstructions.
基于狭窄长度前瞻性评估一种不可切除的食管胃交界部肿瘤姑息治疗算法。
86例恶性食管胃梗阻患者因吞咽困难被转诊至介入放射科行球囊扩张或支架置入术。短节段（≤4 cm）狭窄患者（n = 39）行球囊扩张，长节段（>4 cm）狭窄患者（n = 47）行支架置入术。球囊扩张组中，16例食管癌患者接受了化疗和放疗，而23例胃癌患者仅接受了化疗。
所有患者的所有操作均取得技术成功（100%）。恶性食管胃交界部球囊扩张和支架置入的总体临床成功率为87%（86例患者中的75例）。球囊扩张组39例患者中有29例（74%）取得临床成功，支架置入组47例患者中有46例（98%）取得临床成功。总体并发症发生率为21%（86例患者中的18例）。支架置入后发生了17例并发症，包括反流（n = 8）、移位（n = 6）、肿瘤过度生长（n = 2）和组织增生（n = 1），而球囊扩张后发生了1例并发症（壁内破裂）。中位无症状生存期和生存期分别为120天（95%置信区间：114, 263）和147天（95%置信区间：98, 196）。
这些治疗策略对于恶性食管胃交界部梗阻患者的姑息治疗似乎是合理的。然而，需要进一步研究以尽量减少这些方法的缺点，并确定不可切除的恶性食管胃交界部梗阻患者的最佳治疗方法。
