Esophageal Cancer: An Updated Review

Michael DiSiena, MD; Alexander Perelman, DO; John Birk, MD; Houman Rezaizadeh, MD

Disclosures

South Med J. 2021;114(3):161-168. 

In This Article

Complications

Common complications related to EC are esophageal strictures, gastrointestinal bleeding, tracheal-esophageal fistulas, and nutritional deficiency/weight loss. With regard to therapy for malignant strictures, high perforation risk along with the need for repeat dilatations has resulted in a shift toward stenting. Self-expandable plastic stents and self-expandable metal stents have shown improved relief of dysphagia over dilation but not without their own risks, including migration of the stent (partially covered metal stents may help prevent stent migration because of tissue grown into the uncovered portion of the stent) and perforation (but at lower rates than repeated dilation).[96,97] Although stenting has been shown to improve dysphagia symptoms, there has not been improvement in nutrition status.[98] Nutritional deficiency and weight loss are best managed with enteral feeding, but before placing a feeding tube in any patient with EC, potential surgical options for the cancer need to be discussed because a feeding tube can complicate a potential esophagectomy or gastric pull-up procedure.[99] As with any gastrointestinal malignancy, there is a risk of bleeding, but given the location of adjacent structures (notably the aorta) near the esophagus, local invasion can lead to brisk bleeding with a high mortality rate. For tumor bleeding, therapies include radiation and localized ablation. EC alone or radiation therapy can lead to tracheal-esophageal fistula formation, which can result in chronic aspiration. Tracheal-esophageal fistula can be managed with stent placement and closure, which have an excellent success rate (86%), but they can compromise the airway. As such, airway stenting also is recommended.[100]

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