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|Year : 2006 | Volume
| Issue : 2 | Page : 68-70
Endoscopically placed guide wire assisted nasogastric tube insertion for palliation of absolute dysphagia in patients with incurable esophageal cancer
Joydeep Purkayastha, Sidhartha Hazarika, Kabindra Bhagabati, Ganesh Das, Bedangshu Saikia
Departments of Surgical Oncology and Palliative Care Unit, Dr. B. Borooah Cancer Institute,Gopinath Nagar, Guwahati - 781016, Assam, India
Flat No A - 1, Purbasha Apartments, Soni Ram Borah Road, Near Bora Service, Guwahati - 781 007, Assam
Carcinoma of the esophagus is a dreadful disease because it causes a lot of distress to the patient due to its adverse effects on swallowing. Many patients present with large incurable disease or undergo disease progression and become incurable. Such patients are advised palliative and symptomatic care. The most distressing symptom that requires palliation in such patients is dysphagia. Many procedures are available for relief of dysphagia, but these are not readily available or are costly. We describe a simple, safe, cost effective and easy to do procedure for palliation of malignant dysphagia by insertion of Ryle's tube over a endoscopically placed guide wire especially suitable for patients of the poor socio-economic strata.
Keywords: Dysphagia, esophageal carcinoma, palliation
|How to cite this article:|
Purkayastha J, Hazarika S, Bhagabati K, Das G, Saikia B. Endoscopically placed guide wire assisted nasogastric tube insertion for palliation of absolute dysphagia in patients with incurable esophageal cancer. Indian J Palliat Care 2006;12:68-70
|How to cite this URL:|
Purkayastha J, Hazarika S, Bhagabati K, Das G, Saikia B. Endoscopically placed guide wire assisted nasogastric tube insertion for palliation of absolute dysphagia in patients with incurable esophageal cancer. Indian J Palliat Care [serial online] 2006 [cited 2013 May 26];12:68-70. Available from: http://www.jpalliativecare.com/text.asp?2006/12/2/68/30248
| » Introduction|| |
Assam falls within the 'Asian oesophageal cancer belt'.About seven hundred new cases of oesophageal cancer are registered at the regional cancer institute here each year. Many patients with advanced disease need palliation of dysphagia. Procedures such as oesophageal dilatation, endoprosthesis, intraluminal radiotherapy, metallic stent and laser recanulation,,,,, have been described. However, these procedures are costly and may not be readily available. We describe our experience of nasogastric tube insertion over a guide wire placed endoscopically and through the malignant growth.
| » Materials and Methods|| |
Two hundred and thirty patients with dysphagia due to incurable oesophageal cancer were taken up for nasogastric tube insertions between July 2003 and December 2005. Blind insertion could be done successfully in 23 (10 %) patients. Only 18 (8%) of our patients could afford self expanding metallic stent (SEMs). The other 189 patients had endoscopically placed guide wire assisted Ryle's tube insertion.
The procedure was done on an out patient basis under surface anaesthesia without sedation. The endoscope was passed into the oesophagus till the proximal extent of the malignant growth. A stainless steel guide wire with a flexible spring tip was then passed through the biopsy channel of the endoscope and pushed through the oesophageal growth for a distance of 10 to 15 cms, till the tip of the guide wire reached the stomach. Holding the guide wire in place, the endoscope was withdrawn and removed. The tip of a 14 Fr sized Ryle's tube was cut, lubricated and passed over the guide wire and through the malignant oesophageal growth to reach the stomach. The nasogastric tube was held in place firmly and the guide wire pulled out through it and removed. The nasogastric tube was brought out through its final position in the nostril by fixing it to a plain rubber catheter passed through the nostril. Endoscopically placed guide wire assisted nasogastric tube insertion was done successfully in 181 out of the 189 patients without complications. The procedure failed in eight patients because of inability to pass the guide wire through the tight stricture caused by the oesophageal growth. These patients subsequently had feeding jejunostomies.
| » Discussion|| |
There are other procedures described for the palliation of dysphagia. Dilatation of malignant oesophageal strictures using bougie dilators or balloon dilators is relatively simple. However, relief is short lived and repeated dilatations are required at frequent intervals and there is a risk of oesophageal perforation.
Oesophageal intubation using prosthetic tubes was started more than a hundred years ago by Symonds. Since then many modifications of design, material and technique of introduction have been done. Tubes used included the Souttar tube, Mosseau-Barbin tube, Celestin tube and Atkinson tube. However, these tubes are associated with complications including perforation, pressure necrosis with or without fistulation, obstruction, tube migration and gastro oesophageal reflux.
SEMs provide rapid, safe and effective relief of dysphagia and can be used for long-term palliation. The main disadvantage of SEMS is the high cost, unaffordable for the majority of our patients.
Intraluminal radiation therapy combined with external radiotherapy has been used as a palliative treatment for advanced inoperable oesophageal cancer. This equipment may be available only in tertiary cancer centres. Endoscopic laser treatment also needs sophisticated equipment and repeated treatments at four to six weekly intervals.
Endoscopically placed guide wire assisted nasogastric tube insertion provides an alternative option for palliation of malignant dysphagia. In 1994 Shukla reported a success rate of 75% in 28 patients over a period of three years. On an average 13% of all oesophageal cancer patients attending our institute every year, require palliation of dysphagia because of incurable disease. The nasogastric tube costs fourteen rupees. The procedure is relatively safe and can be performed on an outpatient basis. Liquid feeds can be started through the tube immediately after insertion and can be easily given at home.
| » Conclusion|| |
The symptom of total dysphagia is distressing. Endoscopically placed guide wire assisted nasogastric tube insertion is an inexpensive and simple alternative when stents are not feasible.
| » References|| |
|1.||Deshpande RK, Patil P, Sharma V, Mohanti BK. Cancers of the Esophagus. In : Rath GK, Mohanty BK, editors. Textbook of radiation oncology: Principles and practice. BI Churchill Livingstone Pvt Ltd: 2000. p. 305-33. |
|2.||Graham DY, Smith JL. Balloon dilatation of benign and malignant esophageal strictures. Blind retrograde balloon dilatation. Gastrointest Endosc 1985;31:171-4. |
|3.||Symonds CJ. The treatment of malignant stricture of the oesophagus by tubage or permanent catheters. Br Med J 1887;1:870-3. |
|4.||Atkinson M, Ferguson R. Fibreoptic endoscopic palliative intubation of inoperable oesophagogastric neoplasms. Br Med J 1977;1:266-7. [PUBMED] [FULLTEXT]|
|5.||Mosca F, Stracqualursi A, Portale TR, Consoli A, Latteri S. Palliative treatment of malignant oesophageal stenosis: The role of self-expanding stent endoscopic implantation. Dis Esophagus 2000;13:301-4 [PUBMED] [FULLTEXT]|
|6.||Mohanti BK, Shukla NK, Chawla S, Ganesh T, Deo SV, Thakur KK, et al . Experience with intraluminal radiotherapy in advanced oesophageal cancer. Trop Gastroenterol 1995;16:27-32. |
|7.||Savage AP, Baigrie RJ, Cobb RA, Barr H, Kettlewell MG. Palliation of malignant dysphagia by laser therapy. Dis Esophagus 1997;10:243-6. [PUBMED] |
|8.||Shukla NK, Goel AK, Seenu V, Nanda R, Deo SV, Kriplani AK. Endoscopically guided placement of nasogastric tubes in patients with oesophageal carcinoma with absolute dysphagia: Report of a 3-year experience. J Surg Oncol 1994;56:217-20. [PUBMED] |