• Humans
• Female
• Male
• Esophageal Neoplasms/complications
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Deglutition Disorders/surgery
• Retrospective Studies
• Tracheoesophageal Fistula/etiology
• Tracheoesophageal Fistula/surgery
• Tracheoesophageal Fistula/therapy
• Aged
• Middle Aged
• Risk Factors
• Self Expandable Metallic Stents/adverse effects
• Foreign-Body Migration/etiology
• Aged, 80 and over
• Sex Factors
• Palliative Care

• Humans
• Adenocarcinoma
• Carcinoma, Squamous Cell
• Esophagus

• Endoscopy, Gastrointestinal
• Esophageal and Gastric Varices
• Gastrointestinal Hemorrhage
• Humans
• Self Expandable Metallic Stents
• Stents

• cancer
• gastroenterology

• Adult
• Aged
• Aged, 80 and over
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Esophageal Neoplasms/therapy
• Esophagogastric Junction/pathology
• Esophagogastric Junction/radiation effects
• Female
• Humans
• Male
• Metals
• Middle Aged
• Palliative Care/methods
• Radiotherapy/adverse effects
• Radiotherapy/methods
• Retrospective Studies
• Stents/adverse effects
• Stents/classification
• Stents/standards
• Treatment Outcome

Self-expanding metal stents are the main palliative treatment modality for unresectable esophageal cancer. Gastroesophageal reflux is a common adverse outcome after placement of esophageal stent for cancer involving the gastroesophageal junction and the gastric cardia. Anti-reflux stents with valve have been designed to prevent the acid reflux. The superiority of anti-reflux stent over standard stent in preventing gastroesophageal reflux has not been established well. This study compares the anti-reflux stent and the standard stent in terms of their efficacy to prevent acid reflux.

To compare the standard and the anti-reflux stents in terms of their efficacy, safety, and complications.

The meta-analysis included 8 randomized clinical trials (RCTs) to compare pooled outcomes of total 395 patients. Primary outcomes include improvement in reflux symptoms and dysphagia score. Secondary outcomes include complications of stent migration, occlusion, and bleeding.

A total of eight RCTs were included in the meta-analysis. Compared to the standard stent, the anti-reflux stent showed a trend towards reduction in the dysphagia score without reaching a statistical significance [Standardized mean difference (SMD): -0.33 (-0.71, 0.05); P = 0.09, I²: 37%]. There was no statistical difference in the gastrointestinal reflux (GER) scores between the two types of stents [SMD: -0.17 (-0.78, 0.45); P = 0.008, I²: 74%]. Compared to standard stent, anti-reflux stent showed no difference in the risk of stent migration [OR: 1.37 (0.66, 2.83); P = 0.40, I²: 0 %], bleeding [OR: 1.43 (0.40, 5.13); P = 0.59, I²: 0 %], and obstruction [OR: 1.66 (0.60, 4.60); P = 0.33, I²: 0 %].

Traditional self-expanding standard esophageal stent and anti-reflux stent with valve are similar in terms of outcomes and complications.

• Self expanding metal stent
• Anti-reflux stent
• Randomized controlled trial
• Esophageal stent
• Meta-analysis

The aim of this study was to analyze the safety and effectiveness of stenting using partially covered self-expandable stents in palliation of dysphagia in patients with unresectable esophageal cancer.

Retrospective analysis of hospital records of all patients who underwent esophageal stenting in the period 2008–2015 was performed. The study included patients with unresectable esophageal and esophagogastric cancer.

There were 442 patients included. Mean age was 56 years (range 28–89), and 379 were males. In 40 (9.0%) patients, stenting was performed in the cervical, in 150 (39.3%)—in the middle thoracic, in 141 (31.9%)—in lower thoracic esophagus and in 111 (25.1%)—in the esophagogastric junction. Stenting resulted in significant alleviation of dysphagia grade (3.0 vs. 1.0, p = 0.00001). During the follow-up, 55 (12.4%) patients experienced recurrent dysphagia due to tumor or granulation tissue overgrowth, and in 18 (4.1%) patients, migration of the stent occurred, for which an independent risk factor was adjuvant chemo- and/or radiation therapy (p = 0.001). Minor complications included chest pain (54.5%), delayed complete stent expansion (12.0%), feeling of a foreign body (25.3%), hiccup (1.6%), gastroesophageal reflux (45.6%) and post-discharge pneumonia (2.5%). A feeling of a foreign body in the esophagus was significantly more common after stenting of the cervical esophagus (p = 0.0001), and hiccup was more common after stenting of the esophagogastric junction (p = 0.02). Major complications included bleeding (1.3%), respiratory insufficiency (0.7%), esophageal perforation (0.9%) and irregular heartburn (2.3%). Overall procedure-related mortality was 0.4%. The median survival time was 117.8 days (range 2–732).

Stenting is an effective procedure in relieving dysphagia in patients with unresectable malignant esophageal stenosis and is associated with low rate of postoperative and long-term complications.

• Colorectal cancer
• Malignant bowel obstruction
• Ovarian cancer
• Palliative surgery
• Surgery
• Value

• Concurrent chemoradiation therapy
• Esophageal fistula
• Esophageal squamous cell carcinoma
• Self‐expandable metal stents

• Aged
• Carcinoma, Squamous Cell/drug therapy
• Carcinoma, Squamous Cell/radiotherapy
• Chemoradiotherapy/methods
• Combined Modality Therapy/methods
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/radiotherapy
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stents/standards

Palliative treatments and stents are necessary for relieving dysphagia in patients with esophageal cancer. The aim of this study was to simultaneously compare available treatments in terms of complications.

Web of Science, Medline, Scopus, Cochrane Library and Embase were searched. Statistical heterogeneity was assessed using the Chi² test and was quantified by I². The results of this study were summarized in terms of Risk Ratio (RR). The random effects model was used to report the results. The rank probability for each treatment was calculated using the p-score.

Out of 17855 references, 24 RCTs reported complications including treatment related death (TRD), bleeding, stent migration, aspiration, severe pain and fistula formation. In the ranking of treatments, thermal ablative therapy (p-score = 0.82), covered Evolution® stent (p-score = 0.70), brachytherapy (p-score = 0.72) and antireflux stent (p-score = 0.74) were better treatments in the network of TRD. Thermal ablative therapy (p-score = 0.86), the conventional stent (p-score = 0.62), covered Evolution® stent (p-score = 0.96) and brachytherapy (p-score = 0.82) were better treatments in the network of bleeding complications. Covered Evolution® (p-score = 0.78), uncovered (p-score = 0.88) and irradiation stents (p-score = 0.65) were better treatments in network of stent migration complications. In the network of severe pain, Conventional self-expandable nitinol alloy covered stent (p-score = 0.73), polyflex (p-score = 0.79), latex prosthesis (p-score = 0.96) and brachytherapy (p-score = 0.65) were better treatments.

According to our results, thermal ablative therapy, covered Evolution® stents, brachytherapy, and antireflux stents are associated with a lower risk of TRD. Moreover, thermal ablative therapy, conventional, covered Evolution® and brachytherapy had lower risks of bleeding. Overall, fewer complications were associated with covered Evolution® stent and brachytherapy.

• Esophageal Neoplasms/surgery
• Fistula/etiology
• Hemorrhage/etiology
• Humans
• Pain/etiology
• Randomized Controlled Trials as Topic
• Stents/adverse effects

• Deglutition disorders
• Endoscopy
• Esophageal neoplasms
• Esophagectomy
• Stents

• Bibliometrics
• Biomedical Research/trends
• Esophageal Neoplasms/genetics
• Esophageal Neoplasms/therapy
• Esophagogastric Junction
• Humans
• Stomach Neoplasms/genetics
• Stomach Neoplasms/therapy

• Deglutition
• Esophageal cancer
• Esophageal leak, fistula, perforation
• Esophageal stents
• Swallowing
• Variceal bleeding, esophageal regeneration

• Adenocarcinoma
• Esophageal cancer
• Esophago-gastric junction
• Gastric cancer
• Palliation
• Recurrence

• cancer
• cost
• emergent
• palliative
• surgery
• value

Advanced squamous cell carcinoma of the oesophagus and gastroesophageal junction usually requires palliative treatment, and the method of choice is stenting. There are several types of stents currently available, including: self-expandable metallic stents (fully or partially covered); self-expandable plastic stents; biodegradable stents. Each of the mentioned stents has its advantages and limitations, and requires a proper, patient-tailored selection. Due to the close anatomical relationship between the oesophagus and bronchial tree, some patients may require bilateral stenting. Oesophageal stenting may not only be considered as a palliative procedure, but can also be implemented to alleviate dysphagia during preoperative chemotherapy and/or radiotherapy.

• dysphagia
• oesophageal cancer
• oesophageal fistula
• stenting

Les patients atteints du cancer de l’œsophage ont souvent une maladie localement avancée, la dysphagie est le symptôme majeur chez la plupart de ces patients, plusieurs modalités thérapeutiques ont été utilisées pour améliorer cette dysphagie. Le but de ce travail est d’étudier l'efficacité et la tolérance de la curiethérapie haut débit de dose (HDR) endo-luminale dans le traitement palliatif des cancers de l’œsophage inopérable. Sur une période de 15 ans, l’étude a inclus les patients atteints de cancer de l’œsophage inopérable et/ou métastatique avec une dysphagie, sans extension à l'hypopharynx ou a la trachée et qui ont bénéficié d'une curiethérapie HDR avec ou sans radiothérapie externe à visée palliative. Au total 46 patients ont été inclus dans l’étude, 58,7% étaient des hommes, 42,2% avaient une dysphagie grade 2 et 37,8% étaient aphagiques, 78,6% des patients étaient performance satus PS 2, l'amaigrissement à été trouvé chez 81,4%, la localisation de la tumeur était surtout au niveau du tiers moyen et inférieur dans 97,8%, la hauteur médiane de la tumeur était de 7 cm (5,5-9), le carcinome épidermoïde était le type histologique le plus fréquent chez 31 patients (70,5%). Après un médiane de suivi de 5 mois, l'amélioration de la dysphagie a été retrouvée chez 76% des malades (p1]. L′incidence la plus élevée est observée dans certains pays notamment en Asie et en Afrique, et l′incidence dans les pays développés occidentaux est en augmentation [2]. Selon le registre du cancer de Rabat 2006-2008, le cancer de l’œsophage est rare et constitue 1,5% de tous les cancers chez l'homme [3]. Le taux de survie globale à 5 ans est de 8%, avec 80% des décès liés à l’évolution locale de la maladie [4]. Pour la minorité des patients avec une maladie localisée, le traitement par radiochimiothérapie concomitante avec ou sans chirurgie permet une amélioration de la survie [5]. Plus de 50% des patients atteints de cancer de l′œsophage ont une maladie inopérable au moment du diagnostic due à une tumeur localement avancée, des métastases ou un mauvais état général avec une médiane de survie globale de 2,5 à 9,9 mois [6]. La majorité de ces patients ont besoin de soins palliatifs pour soulager la dysphagie qui est présente chez plus de 70% des patients et qui est responsable d'une dégradation importante de la qualité de vie [7]. À l′heure actuelle, plusieurs modalités de prise en charge sont disponibles pour le traitement palliatif de cette dysphagie. Les options de traitement les plus couramment utilisées comprennent le placement de stent métallique [8–10], le traitement au laser [11], et la curiethérapie avec ou sans radiothérapie externe et ou éventuellement une chimiothérapie [12–15]. Une méta-analyse a conclu qu'il n'y a pas de supériorité claire de l'une des méthodes utilisées dans la palliation du cancer de l’œsophage, le choix de l'une de ces méthodes dépend de l'expérience du centre et de l’état du patient. Cette méta-analyse a aussi démontré que la pose d'une prothèse métallique expansible et la curiethérapie étaient les deux méthodes de référence, la première étant la plus rapide pour améliorer la dysphagie, mais la seconde constitue une réelle alternative pouvant améliorer la survie et la qualité de vie [16]. Un inconvénient du traitement au laser est la nécessité de répéter les séances afin d'obtenir et de maintenir le bénéfice [17, 18]. Dans notre centre la curiethérapie est souvent utilisée pour pallier à la dysphagie. Le but de notre travail est de déterminer l'efficacité et la tolérance de la curiethérapie dans le traitement palliatif du cancer de l’œsophage.

• Esophageal cancer
• HDR brachytherapy
• dysphagia

• Dysphagia relief
• Esophageal carcinoma
• Gastric carcinoma
• Gastroesophageal junction cancer
• Palliative therapy
• Stent placement

• Bleeding
• Diagnosis and management of severe complications
• Embolization
• GI emergencies
• GI endoscopy adverse events
• Haemorrhage
• Infection
• Perforation

• Emergencies
• Endoscopy, Gastrointestinal/adverse effects
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Gastrointestinal Tract/injuries
• Humans
• Wounds and Injuries/diagnosis
• Wounds and Injuries/etiology
• Wounds and Injuries/surgery

• Malignancy
• Obstruction
• Stents
• Upper gastrointestinal tract

• Barrett esophagus
• esophagus
• health-related quality of life
• incidence
• neoplasm
• patterns
• prognosis
• therapy

• Adenocarcinoma/diagnosis
• Adenocarcinoma/etiology
• Adenocarcinoma/mortality
• Adenocarcinoma/therapy
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Barrett Esophagus/pathology
• Biomarkers, Tumor/genetics
• Biomarkers, Tumor/metabolism
• Breast Feeding
• Combined Modality Therapy
• Critical Pathways
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Early Detection of Cancer
• Endoscopy, Gastrointestinal
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/etiology
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/therapy
• Esophagectomy/methods
• Gastroesophageal Reflux/complications
• Gastroesophageal Reflux/drug therapy
• Genes, erbB-2
• Genetic Predisposition to Disease
• Gonadal Steroid Hormones/metabolism
• Helicobacter Infections/complications
• Helicobacter pylori
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
• Incidence
• Obesity/complications
• Obesity/therapy
• Palliative Care
• Postoperative Period
• Preoperative Care
• Primary Prevention
• Prognosis
• Proton Pump Inhibitors/therapeutic use
• Quality of Life
• Risk Factors
• Sex Distribution
• Stents
• Weight Loss

• Endoscopic stent placement
• endoscopy
• obstructing tumours
• palliation
• wall stent

• Duodenal Diseases/therapy
• Esophageal Diseases/therapy
• Esophageal Stenosis/therapy
• Gastric Outlet Obstruction/therapy
• Humans
• Quality of Life/psychology
• Stents
• Stomach Diseases/therapy
• Time Factors
• Upper Gastrointestinal Tract/pathology

Our aim was to compare survival of the various treatment modality groups of chemotherapy and/or radiotherapy in relation to SEMS (self-expanding metal stents) in a retrospective case-control study. We have made the hypothesis that the administration of combined chemoradiotherapy improves survival in inoperable esophageal cancer patients.

All patients were confirmed histologically as having surgically non- resectable esophageal carcinoma. Included were patients with squamous cell carcinoma, undifferentiated carcinoma as well as Siewert type I--but not type II - esophagogastric junctional adenocarcinoma. The decision to proceed with palliative treatments was taken within the context of a multidisciplinary team meeting and full expert review based on patient's wish, co-morbid disease, clinical metastases, distant metastases, M1 nodal metastases, T4-tumor airway, aorta, main stem bronchi, cardiac invasion, and peritoneal disease. Patients not fit enough to tolerate a radical course of definitive chemo- and/or radiation therapy were referred for self-expanding metal stent insertion. Our approach to deal with potential confounders was to match subjects according to their clinical characteristics (contraindications for surgery) and tumor stage according to diagnostic work-up in four groups: SEMS group (A), Chemotherapy group (B), Radiotherapy group (C), and Chemoradiotherapy group (D).

Esophagectomy was contraindicated in 155 (35.5%) out of 437 patients presenting with esophageal cancer to the Department of General and Abdominal Surgery of the University Hospital of Mainz, Germany, between November 1997 and November 2007. There were 133 males and 22 females with a median age of 64.3 (43-88) years. Out of 155 patients, 123 were assigned to four groups: SEMS group (A) n = 26, Chemotherapy group (B) n = 12, Radiotherapy group (C) n = 23 and Chemoradiotherapy group (D) n = 62. Mean patient survival for the 4 groups was as follows: Group A: 6.92 ± 8.4 months; Group B: 7.75 ± 6.6 months; Group C: 8.56 ± 9.5 months, and Group D: 13.53 ± 14.7 months. Significant differences in overall survival were associated with tumor histology (P = 0.027), tumor localization (P = 0.019), and type of therapy (P = 0.005), respectively, in univariate analysis. Treatment modality (P = 0.043) was the only independent predictor of survival in multivariate analysis. The difference in overall survival between Group A and Group D was highly significant (P < 0.01) and in favor of Group D. As concerns Group D versus Group B and Group D versus Group C there was a trend towards a difference in overall survival in favor of Group D (P = 0.069 and P = 0.059, respectively).

The prognosis of inoperable esophageal cancer seems to be highly dependent on the suitability of the induction of patient-specific therapeutic measures and is significantly better, when chemoradiotherapy is applied.