Jensen D M, Machicado G, Randall G, Tung L A, English-Zych S
Medical Service, UCLA Center for the Health Sciences.
Gastroenterology. 1988 Jun;94(6):1263-70. doi: 10.1016/0016-5085(88)90662-2.
The purposes of this study were (a) to determine the applicability of endoscopic palliation for patients with esophagogastric cancer strictures in a referral center, and (b) to compare the efficacy and safety of the BICAP tumor probe with the neodymiumyttrium-aluminum-garnet (YAG) laser for such palliation. Forty-two consecutive patients with weight loss and obstructive symptoms from an unresectable, malignant esophageal stricture were referred for endoscopic palliation. Fourteen patients did not meet the criteria for YAG laser or BICAP tumor probe treatment and other therapies were recommended. Twenty-eight patients were treated, the first 14 with low-power YAG laser and the last 14 with BICAP tumor probe. All patients had coagulation of malignant strictures in one session. Treated patients were similar in background variables and stricture lengths but twice as much thermal energy was needed for the YAG laser as the BICAP tumor probe treatment. Treatment results were not statistically different during the median follow-up and survival of 16 wk. As minor complications, either pain or edema requiring dilatation was more common in the YAG laser-treated group than the BICAP tumor probe group. Treatment-related esophageal strictures developed in 21% of patients treated with YAG laser. A fistula developed in 1 patient with noncircumferential cancer in the BICAP tumor probe group. Compared with only the intake of liquids before treatment, 86% of patients could eat a soft or solid diet after initial treatment with BICAP tumor probe or YAG laser. Our conclusions were that for BICAP tumor probe and YAG laser, endoscopic palliation efficacy and safety for circumferential esophageal cancer strictures were similar. The advantages of using the BICAP tumor probe were portability, lower equipment costs, and the ability to treat submucosal, long, or high esophageal cancer strictures in one session. Treatment with YAG laser was safer than BICAP tumor probe for exophytic, noncircumferential cancers because the laser could be directed endoscopically. Use of the BICAP tumor probe is not recommended for noncircumferential esophagogastric cancer strictures.
（a）确定在一家转诊中心，内镜下姑息治疗对食管胃癌狭窄患者的适用性；（b）比较BICAP肿瘤探头与钕钇铝石榴石（YAG）激光用于此类姑息治疗的疗效和安全性。42例因不可切除的恶性食管狭窄而体重减轻且有梗阻症状的连续患者被转诊接受内镜下姑息治疗。14例患者不符合YAG激光或BICAP肿瘤探头治疗标准，建议采用其他治疗方法。28例患者接受了治疗，前14例采用低功率YAG激光治疗，后14例采用BICAP肿瘤探头治疗。所有患者均在一次治疗中对恶性狭窄进行了凝固治疗。接受治疗的患者在背景变量和狭窄长度方面相似，但YAG激光治疗所需的热能是BICAP肿瘤探头治疗的两倍。在中位随访期16周和生存期内，治疗结果无统计学差异。作为轻微并发症，YAG激光治疗组中需要扩张的疼痛或水肿比BICAP肿瘤探头组更常见。接受YAG激光治疗的患者中有21%发生了与治疗相关的食管狭窄。BICAP肿瘤探头组中有1例非环周性癌症患者发生了瘘管。与治疗前仅能摄入液体相比，86%的患者在初次接受BICAP肿瘤探头或YAG激光治疗后能够进食软食或固体食物。我们的结论是，对于BICAP肿瘤探头和YAG激光，内镜下姑息治疗对环周性食管癌狭窄的疗效和安全性相似。使用BICAP肿瘤探头的优点是便携、设备成本较低，并且能够在一次治疗中治疗黏膜下、长或高位食管癌狭窄。对于外生性、非环周性癌症，YAG激光治疗比BICAP肿瘤探头更安全，因为激光可通过内镜引导。不建议将BICAP肿瘤探头用于非环周性食管胃癌狭窄。
