Electrochemical therapy in palliative treatment of malignant dysphagia: a pilot study

BACKGROUND/AIMS: Electrochemical therapy (ECT), a method based on the appli cation of a low-level direct current, was employed in this study to relieve severe dysphagia. In addition, we aimed to assess the efficacy, safety and requirements for follow-up re-interventions. METHODOLOGY: Sixteen patients with inoperable and circumferential malignant stenosis of the esophagus were palliated by ECT at presentation and then r epeatedly whenever tumor growth and dysphagia recurred. The electrode was i nserted and placed at the level of stenosis under fluoroscopic guidance, an d an electric quantity of 300-560 coulombs (5-6.5 V; 60-90 mA) was given. W hen total luminal occlusion was found, prior balloon dilatation enabled ins ertion of the electrode. Patients with squamous cell carcinoma also receive d external beam radiotherapy of 20-30 Gy in 10 daily fractions. Dysphagia w as graded on a scale of O to 4 (O=normal; 4=complete dysphagia), and follow -up esophagograms were obtained for response evaluation. RESULTS: The severity of dysphagia decreased by 1-4 (median: 2) grades with an improvement in 6 patients with totally obstructing lesions. Dysphagia r ecurred in all but 1 patient after a median interval of 10 weeks, but was e asily treated with repeat ECT sessions. However, 2 patients became unrespon sive to ECT after 7 and 3 months of therapy, respectively. There were no EC T-related complications. CONCLUSIONS: In conclusion, this pilot study suggests that electrochemical therapy may provide safe and effective palliation of narrowing and circumfe rential esophageal carcinoma. It requires repeat interventions and dilatati on expertise is necessary for insertion of the electrode through the totall y obstructing lesion.