Esophageal Carcinoma, Therapeutic Approach,  El Salvador Atlas of Gastrointestinal VideoEndoscopy,  A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Obstructed Esophageal Squamous Cell Carcinoma of the middle third. Palliative Treatment. An  84 year-old male, who three months previous had had diagnosis of this neoplasia. The patient and his family rejected surgical treatment, radiotherapy or chemotherapy. The Patient had dysphagia to liquids and solids with intense sialorrea due to the obstruction caused by the tumor.  Cure of patients with esophageal cancer has remained rare over the past four decades.

Video Endoscopic Sequence 1 of 18.

Palliation of Dysphagia of Esophageal Cancer by Endoscopic Lumen Restoration with Intraluminal Tumor Debulking.

 Obstructed Esophageal Squamous Cell Carcinoma of the
 middle third.

Palliative Treatment to enabling passage of normal food.

 An 84 year-old male, three months before had had a
 diagnosis of this neoplasia. The patient and his family
 rejected surgical treatment, radiotherapy or chemotherapy.

 The Patient had dysphagia to liquids and solids with intense
 sialorrea due to the obstruction caused by the tumor.
 Patients with esophageal carcinoma generally lose their
 chance of curable surgical treatment when symptoms
 become evident. At this stage chemoradiotherapy and
 palliative treatment methods are the only options.

 Cure of patients with esophageal cancer has remained rare
 over the past four decades.

 Download the video clips by clicking on the endoscopic
 images.

In this Patient, as palliative treatment we used several therapeutic resources like this hydrostatic dilatador, coagulation with argon plasma (APC). Peroral dilation can restore esophageal lumen patency, albeit temporarily, to a diameter adequate to permit adequate swallowing in over 90% of patients.

Video Endoscopic Sequence 2 of 18.

 Esophageal Dilation

 In this Patient, as palliative treatment we used several
 therapeutic resources like this hydrostatic dilator,
 coagulation with argon plasma (APC).

 Peroral dilation can restore esophageal lumen patency,
 albeit temporarily, to a diameter adequate to permit
 adequate swallowing in over 90% of patients.

Debulking of the tumor. Palliative treatment with  high power setting of argon plasma coagulator APC. The image and the video clip shows the APC catheter, The APC probe produces a plasma arc that destroys tissue to a depth of approximately 2 to 3 mm. Palliation is the only realistic therapeutic option for these patients. Available palliative treatment modalities include chemotherapy, radiation therapy, esophageal dilation, multipolar electrocoagulation, laser treatment, injection of sclerosing agents, photodynamic therapy, and esophageal endoprostheses.

Video Endoscopic Sequence 3 of 18.

 Debulking of the tumor.

 Palliative treatment with high power setting of argon
 plasma coagulator APC.

 The image and the video clip shows the APC catheter,
 The APC probe produces a plasma arc that destroys tissue
 to a depth of approximately 2 to 3 mm.

 Palliation is the only realistic therapeutic option for these
 patients. Available palliative treatment modalities include
 chemotherapy, radiation therapy, esophageal dilation,
 multipolar electrocoagulation, laser treatment, injection of
 sclerosing agents, photodynamic therapy, and esophageal
 endoprostheses
.

A special forceps was used to remove neoplastic tissues. The normal esophageal lumen measures approximately 25 mm in functional diameter. When the lumen diameter is decreased to 13 mm, everyone has solid food or regular diet dysphagia. When the lumen diameter is less than 18 mm, selective alteration of diet content and consistency is necessary, depending on the characteristics of the stricture. Milder degrees of stricture are easier and safer to dilate than severe strictures. It is illogical to delay therapy until the patient is able to swallow only liquids, even though adequate total caloric intake has been possible by using a full liquid diet plus dietary supplements.

Video Endoscopic Sequence 4 of 18.

A special forceps was used to remove neoplastic tissues.

 The normal esophageal lumen measures approximately 25 mm in
 functional diameter. When the lumen diameter is decreased to
 13 mm, everyone has solid food or regular diet dysphagia. When
 the lumen diameter is less than 18 mm, selective alteration of diet
 content and consistency is necessary, depending on the
 characteristics of the stricture. Milder degrees of stricture are
 easier and safer to dilate than severe strictures. It is illogical to
 delay therapy until the patient is able to swallow only liquids,
 even though adequate total caloric intake has been possible by
 using a full liquid diet plus dietary supplements.

 

Devitalization of pathologic tissue.  The video clip shows a large segment of tumor was removed with this forceps.

Video Endoscopic Sequence 5 of 18.

Devitalization of Pathologic Tissue. 

 The video clip shows a large segment of tumor that was
 removed with this forceps.

 Tumor treatment, especially in the case of bulky tumors,
 requires effective devitalization and precisely defined depth
 of thermal effect for reducing tumor mass while
 simultaneously avoiding hemorrhages or perforation.

Palliation of non-resectable carcinoma of the cardia and esophagus by argon beam coagulation. More aggressive setting of argon plasma coagulation.

Video Endoscopic Sequence 6 of 18.

Palliation of non-resectable carcinoma of the cardia and esophagus by argon beam coagulation.

 More aggressive setting of argon plasma coagulation.

 

Methods: APC as non-contact, high-frequency electrosurgery under inert argon plasma atmosphere allows dissection, hemostasis, and desiccation of tumor tissue in a one-step procedure. In consideration of the limited and heterogeneous group of patients, results are interpreted descriptively.

Video Endoscopic Sequence 7 of 18.

 Methods: APC as non-contact, high-frequency
 electrosurgery under inert argon plasma atmosphere
 allows dissection, hemostasis, and desiccation of tumor
 tissue in a one-step procedure. In consideration of the
 limited and heterogeneous group of patients, results are
 interpreted descriptively.

 

The tumor that have been  debulked partially .   Restoration and preservation of the lumen for subsequent passage of the corresponding endoscope.

Video Endoscopic Sequence 8 of 18.

 The tumor that have been debulked partially.

Restoration and preservation of the lumen for subsequent passage of the corresponding endoscope.

 

Final status after the therapeutic endoscopy,   with  three different days, we could introduce the endoscope to the gastric camera.   Prior to stent placement, a complete endoscopic examination should be performed to assess the proximal and distal extent of the stricture. In this video clip you can see the entire segment of the tumor that have been debulked partially.

Video Endoscopic Sequence 9 of 18.

 Recanalization of the Esophagus.

 Final status after the therapeutic endoscopy, with three
 different days, we could introduce the endoscope to the
 gastric camera.

 Prior to stent placement, a complete endoscopic
 examination should be performed to assess the proximal
 and distal extent of the stricture.

 In this video clip you can see the entire segment of the
 tumor that have been debulked
partially.

The preparation of Z-stent in the room of fluroscopy is observed. The Z-stent has good expansile force, and a new design incorporates an antireflux valve for bridging the gastroesophageal (GE) junction. S-EMS = self-expandable metallic stent.

Video Endoscopic Sequence 10 of 18.

 The preparation of Z-stent in the room of fluroscopy is
 observed.

 The Z-stent has good expansile force, and a new design
 incorporates an antireflux valve for bridging the
 gastroesophageal (GE) junction.

 S-EMS = self-expandable metallic stent.

 Download the video clip by clicking on the image.

The stenosis caused by the tumor is observed in this fluroscopy video clip.     Endoscopic insertion of a stent is an important option in the palliative management of esophageal obstruction.

Video Endoscopic Sequence 11 of 18.

The stenosis caused by the tumor is observed in this fluroscopy video clip.

Endoscopic insertion of a stent is an important option in the palliative management of esophageal obstruction.

 

The Stent has been placed in the middle of the esophagus. Although esophageal stent therapy is only a palliative measure for patients with inoperable tumors, it remains an important method for maintaining quality of life. In particular, the usefulness of a covered S-EMS as therapy for a malignant esophageal obstruction has been reported.

Video Endoscopic Sequence 12 of 18.

 The Stent has been placed in the middle of the esophagus.

 Although esophageal stent therapy is only a palliative measure for
 patients with inoperable tumors, it remains an important method
 for maintaining quality of life. In particular, the usefulness of a
 covered S-EMS as therapy for a malignant esophageal
 obstruction has been reported.

Endoscopic-placed stent to provide palliation of dysphagia. The patient obtained a significant improvement in the quality of life. Successfully deployed Self-expanding stent in the esophagus under fluroscopy control. This image and the video clip were taken one week after the procedure. Esophageal Z-Stent with dual anti-reflux valve is used to maintain patency of malignant esophageal strictures and to decrease esophageal reflux and aspiration.  Effective method of palliating dysphagia related to stricture caused by malignant esophageal lesions. Esophageal balloon dilation and expandable stent placement are safe, minimally invasive, effective treatments for esophageal malign strictures. These procedures have brought the management of dysphagia due to esophageal strictures into the field of interventional radiology. Esophageal dilation is usually indicated for benign stenoses and is technically successful in more than 90% of cases. Most patients with esophageal carcinoma are not candidates for resection; thus, the main focus of treatment is palliation of malignant dysphagia.

Video Endoscopic Sequence 13 of 18.

 Endoscopic-placed stent to provide palliation of dysphagia.

 The patient obtained a significant improvement in the
 quality of life.

 Successfully deployed Self-expanding stent in the
 esophagus under fluroscopy control.
 This image and the video clip were taken one week after
 the procedure.

 Esophageal Z-Stent with dua anti-reflux valve is used to
 maintain patency of malignant esophageal strictures and
 to decrease esophageal reflux and aspiration.

 Effective method of palliating dysphagia related to stricture
 caused by malignant esophageal lesions.

 Esophageal balloon dilation and expandable stent
 placement are safe, minimally invasive, effective
 treatments for esophageal malign strictures.

 These procedures have brought the management of
 dysphagia due to esophageal strictures into the field of
 interventional radiology. Esophageal dilation is usually
 indicated for benign stenoses and is technically successful
 in more than 90% of cases. Most patients with esophageal
 carcinoma are not candidates for resection; thus, the main
 focus of treatment is palliation of malignant dysphagia.

 

This antireflux stent is as safe and effective as the standard open stent in relieving malignant dysphagia and was successful in reducing symptomatic gastroesophageal reflux.

Video Endoscopic Sequence 14 of 18.

 This antireflux stent is as safe and effective as the
 standard open stent in relieving malignant dysphagia and
 was successful in reducing symptomatic gastroesophageal
 reflux.

 Esophageal stent placement improved his oral alimentation
 status.

 Esophageal stent placement, which is approved only for
 malignant strictures, is one of the main therapeutic options
 in affected patients and relieves dysphagia in
 approximately 90% of cases. Dedicated commercially
 available devices continue to evolve, each with its own
 advantages and limitations. Stent placement is subject to
 technical pitfalls, and adverse events occur following
 esophageal procedures in a minority of cases. Although
 chest pain is common and self-limited, reflux esophagitis,
 stent migration, tracheal compression, and esophageal
 perforation and obstruction require specific interventions.
 In many cases, these complications can be recognized and
 treated by the interventional radiologist with minimally
 invasive techniques.

In this retroflexed image is observed the stent that emerging from the gastric fundus, the anti-reflux valves are observed  in the tip.

Video Endoscopic Sequence 15 of 18.

 In this retroflexed image is observed the stent that
 emerging from the gastric fundus, the
anti-reflux valves
 are observed in the tip.

 Stent therapy using a self-expandable metallic stent (S-EMS) in
 patients, with esophageal stenosis has resulted in improvements to
 the quality of life for patients with inoperable esophageal cancer.
 However, stent-related, complications such as hemorrhage,
 rupture, stent migration, granulation tissue formation, and
 esophagotracheobronchial fistula have been reported.
  

There is an epithelial perl with keratin. There are also malignant Squamous cells, with keratin. This is an epidermoid carcinoma, well differentiated.

Video Endoscopic Sequence 16 of 18.

 There is an epithelial perl with keratin. There are also
 malignant Squamous cells, with keratin. This is an
 epidermoid carcinoma, well differentiated.

 

Chest radiograph demonstrating stent position. Re-establishing the esophageal lumen offers palliation of malignant dysphagia, which is the mainstay of therapy in patients with incurable esophageal cancer

Video Endoscopic Sequence 17 of 18.

Chest radiograph demonstrating stent position.

 Re-establishing the esophageal lumen offers palliation of
 malignant dysphagia, which is the mainstay of therapy in
 patients with incurable esophageal cancer.

 

Cat Scan.  Performing this debulking method and placement of the stent palliation was achieved in the patient.  Recanalization enabling passage for normal food was achieved.    Most patients with esophageal cancer will require palliation for the multiple problems that develop during their limited life span.  The responsibility of the palliation therapist is to provide the patient with safe and cost-effective treatments that provide the best possible dysphagia relief.

Video Endoscopic Sequence 18 of 18.

Cat Scan.

 Performing this debulking method and placement of the
 stent p
alliation was achieved in the patient.

 Recanalization enabling passage for normal food was
 achieved.

 Most patients with esophageal cancer will require palliation
 for the multiple problems that develop during their limited
 life span. The responsibility of the palliation therapist is to
 provide the patient with safe and cost-effective treatments
 that provide the best possible dysphagia relief.