Background: Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment opti...Background: Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment options. As an alternative and/or complementary therapy, radiologic techniques (external beam radiation/brachy therapy) and locally endoscopic techniques (laser, APC-beamer, PDT) are often used. Study and Goals: Retrospective trial of 153 patients treated in our department between 1993 and 2001. Forty-five patients received a plastic tube ( Group A) and 108 patients were treated with metal stents (Group B). Both groups were compared for improvement of dysphagia score, survival, recurrent dysphagia and complications. Results: Stent placement was successful in 41 of 45 (93%) pa tients of Group A and 107 of 108 (99%) of Group B. The median dysphagia score i mproved significantly in Group A (from 3.03 to 1.55, P = 0.010) and Group B (fro m 2.77 to 1.44, P = 0.009). Recurrent dysphagia was noted in 12 of 45 (27%) pat ients of Group A and 27 of 108 (25%) patients of Group B. Median survival time after stent insertion was 78 days (Group A) and 113 days (Group B). Overall comp lications occurred in 15 of 45 (33%) patients of Group A and 28 of 108 (26%) p atients of Group B. However, significantly (P = 0.05) more major complications w ere seen in Group A than in Group B (22%vs. 9%). Conclusions: Our results indi cate a marginal clinical benefit for metal stents versus plastic tubes in malign ant dysphagia in the long run. However, metal stents seem to be safer and associ ated with a prolonged improvement of dysphagia score.展开更多
Background and study aims: Premalignant duodenal polyps are considered to be rare. Recurrence after local excision is reported to be frequent, so many authors propose radical surgical treatment of these tumors. The ai...Background and study aims: Premalignant duodenal polyps are considered to be rare. Recurrence after local excision is reported to be frequent, so many authors propose radical surgical treatment of these tumors. The aim of this study was to determine the long-term outcome after endoscopic resection of duodenal adenomas. Patients and methods: Between January 1990 and April 2003 we retrospectively evaluated a group of patients who presented with nonampullary duodenal villous tumors but who did not have a polyposis syndrome. Results: Duodenal polyps were diagnosed in 21 patients during routine endoscopy during the study period. Of these, 18 patients (6 men, 12 women; median age 67, range 50-81), with a total of 20 duodenal adenomas, were enrolled into the study. The median size ±SD of the tumors was 27.5 ±12 mm (range 8-50 mm). Of these 20 tumors, 18 adenomas were tubulovillous, one was tubulous and one was villous. Nineteen polyps were treated by snare excision and one adenoma was treated with argon plasma coagulation alone. Argon plasma coagulation was applied to polyps in six patients after snare excision during this initial treatment phase. The success rate for endoscopic adenoma removal after a 3-month interval was 55%. After a median follow-up period of 71 months (range 22-151 months), 12 patients remained in remission. Local recurrences of the lesion occured in five patients (25%) and these were re-treated. None of the patients developed carcinoma during the follow-up period. Conclusions: Endoscopic snare excision of duodenal adenomas is an effective mode of treatment but an endoscopic surveillance program is mandatory in order to detect and treat recurrence.展开更多
文摘Background: Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment options. As an alternative and/or complementary therapy, radiologic techniques (external beam radiation/brachy therapy) and locally endoscopic techniques (laser, APC-beamer, PDT) are often used. Study and Goals: Retrospective trial of 153 patients treated in our department between 1993 and 2001. Forty-five patients received a plastic tube ( Group A) and 108 patients were treated with metal stents (Group B). Both groups were compared for improvement of dysphagia score, survival, recurrent dysphagia and complications. Results: Stent placement was successful in 41 of 45 (93%) pa tients of Group A and 107 of 108 (99%) of Group B. The median dysphagia score i mproved significantly in Group A (from 3.03 to 1.55, P = 0.010) and Group B (fro m 2.77 to 1.44, P = 0.009). Recurrent dysphagia was noted in 12 of 45 (27%) pat ients of Group A and 27 of 108 (25%) patients of Group B. Median survival time after stent insertion was 78 days (Group A) and 113 days (Group B). Overall comp lications occurred in 15 of 45 (33%) patients of Group A and 28 of 108 (26%) p atients of Group B. However, significantly (P = 0.05) more major complications w ere seen in Group A than in Group B (22%vs. 9%). Conclusions: Our results indi cate a marginal clinical benefit for metal stents versus plastic tubes in malign ant dysphagia in the long run. However, metal stents seem to be safer and associ ated with a prolonged improvement of dysphagia score.
文摘Background and study aims: Premalignant duodenal polyps are considered to be rare. Recurrence after local excision is reported to be frequent, so many authors propose radical surgical treatment of these tumors. The aim of this study was to determine the long-term outcome after endoscopic resection of duodenal adenomas. Patients and methods: Between January 1990 and April 2003 we retrospectively evaluated a group of patients who presented with nonampullary duodenal villous tumors but who did not have a polyposis syndrome. Results: Duodenal polyps were diagnosed in 21 patients during routine endoscopy during the study period. Of these, 18 patients (6 men, 12 women; median age 67, range 50-81), with a total of 20 duodenal adenomas, were enrolled into the study. The median size ±SD of the tumors was 27.5 ±12 mm (range 8-50 mm). Of these 20 tumors, 18 adenomas were tubulovillous, one was tubulous and one was villous. Nineteen polyps were treated by snare excision and one adenoma was treated with argon plasma coagulation alone. Argon plasma coagulation was applied to polyps in six patients after snare excision during this initial treatment phase. The success rate for endoscopic adenoma removal after a 3-month interval was 55%. After a median follow-up period of 71 months (range 22-151 months), 12 patients remained in remission. Local recurrences of the lesion occured in five patients (25%) and these were re-treated. None of the patients developed carcinoma during the follow-up period. Conclusions: Endoscopic snare excision of duodenal adenomas is an effective mode of treatment but an endoscopic surveillance program is mandatory in order to detect and treat recurrence.
