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Proceedings Paper

Self-expanding metal mesh stents and laser therapy: a complementary approach for the palliation of malignant dysphagia
Author(s): Ravi Madhotra; A. Raouf; R. Sturgess; Neville Krasner M.D.
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Paper Abstract

Re-establishment of the oesophageal lumen is the main focus of care in patients with inoperable oesophageal carcinomas. The self-expanding metal mesh stents (MMS) are increasingly being used. 51 patients aged 44 - 89 with inoperable oesophago-gastric carcinomas were intubated with MMS. 18 of these patients had endoscopic laser therapy (ELT) as primary palliation. 25 patients required follow-up endoscopy at variable intervals after stent insertion. 17 patients were found to have significant tumor growth (9), overgrowth (4) and both (4). All these patients were treated with Nd:YAG or diode laser for maintenance of satisfactory swallowing. 4 patients being treated with Nd:YAG laser developed deformity of MMS. This complication was not encountered with diode laser. The reblockage of MMS due to ingrowth or overgrowth of tumor is a not uncommon complication. The timing of the stent insertion should be carefully chosen since the longer the stent is in situ, the greater is the likelihood of tumor ingrowth or overgrowth. ELT can effectively deal with tumor ingrowth and overgrowth. Nd:YAG laser can cause melting of MMS. Overall the combination of ELT and MMS may offer the best palliation, particularly when patient survival of several months is anticipated.

Paper Details

Date Published: 22 December 1997
PDF: 4 pages
Proc. SPIE 3192, Medical Applications of Lasers in Dermatology, Ophthalmology, Dentistry, and Endoscopy, (22 December 1997); doi: 10.1117/12.297853
Show Author Affiliations
Ravi Madhotra, Fazakerley Hospital (United Kingdom)
A. Raouf, Fazakerley Hospital (United Kingdom)
R. Sturgess, Fazakerley Hospital (United Kingdom)
Neville Krasner M.D., Fazakerley Hospital (United Kingdom)

Published in SPIE Proceedings Vol. 3192:
Medical Applications of Lasers in Dermatology, Ophthalmology, Dentistry, and Endoscopy
Gregory B. Altshuler; Reginald Birngruber; Marco Dal Fante; Raimund Hibst; Herbert Hoenigsmann; Neville Krasner M.D.; Frederic Laffitte, Editor(s)

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