PALLIATIVE BIPOLAR ELECTROCOAGULATION TRE ATMENT OF OBSTRUCTING ESOPHAGEAL CANCER

Objective patients and methods. - The objective of this study was to e valuate the results of palliative bipolar electrocoagulation probe (BI CAP) treatment in 26 patients with non surgical, obstructive esophagea l cancer. The mean tumor length was 7.2 cm. The strictures were locate d as follows: 3 in the cervical esophagus, 8 in the thoracic esophagus , 13 in the distal third of the esophagus and 2 involved both the cerv ical and thoracic esophagus. Most lesions were circumferential (73% ve rsus 27% non circumferential) and exophytic (78% versus 22% sub mucosa l). Coagulation was carried out under direct endoscopic control in the forward direction. The success of treatment was evaluated on the basi s of the degree of reopening achieved (easy passage of an endoscope 12 mm in diameter) and good functional results (improvement of dysphagia , scored from 0 to 4 using a standard grading scale, for more than 15 days). Results. - Twenty-six patients underwent a total of 45 BICAP tr eatments (31 initial sessions, 14 repeated sessions). Reopening was ac hieved in 92% of cases and good function results were obtained in 85% (mean dysphagia score: 3.2 before treatment versus 1.1 after treatment ). The improvement of dysphagia resulted in a significant improvement of general performance status and stabilization or weight improvement in 21 patients. The mean number of sessions necessary for good initial results was 1.2 +/- 0.4. After the initial treatment by BICAP, radiot herapy or radiochemotherapy were respectively associated in 4 and 10 p atients. The median duration of improvement was significantly longer i n patients who underwent radiochemotherapy as compared with patients t reated by BICAP alone (22 weeks versus 4 weeks). During the follow-up, 9 patients required several BICAP treatments and at the end of their disease, 12 patients underwent other palliative procedures. Major comp lications occurred in 4 cases (2 eso-tracheal fistulas, 1 hemorrhage, and 1 aspiration pneumonia) and mortality related to the procedure was 8%. Conclusions. - Palliative BICAP treatment of obstructing esophage al and cardial cancer provide quick relief of dysphagia but repeated t reatment sessions are necessary to maintain initial improvement. The p rocedure requires a short hospitalization stay and can be easily accom plished in all cases regardless of the tumor features.