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Gastroenterology


Answer 4
  1. Placement of an esophageal stent. Endoscopic stents are the current mainstay of therapy for malignant dysphagia for unresectable esophageal cancer. Modern endoscopic stents are self-expanding and are almost universally coated to avoid tissue ingrowth through the stent interstices. Most patients with esophageal stents experience marked and rapid improvement in dysphagia, although such devices are not without the risk of complications (eg, perforation, bleeding). Gastrotomy or jejunostomy tubes are possible management options but would not allow a return to oral feeding, which would be preferable. Laser therapy is effective but is rarely performed. Lasers are currently not widely available, and patients often need multiple sessions of treatment to relieve dysphagia. Balloon dilation works well for benign esophageal strictures but is largely ineffective for malignant stenoses.

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