Upper Gastrointestinal Stenoses Intubation Laser Treatment

Intubation

Laser Treatment

Principle and Key Characteristics

► Principle: insertion of a molded plastic tube into a stricture

► Established, economical treatment method

► Increasingly superseded by self-expanding stents

► Disadvantages

- Frequently requires general anesthesia.

- Stricture must be dilated to 15-18 mm before intubation.

Indications

► Malignant esophageal strictures with or without a fistula

► Long, circumferential strictures without angulation

► Malignant strictures of the gastric cardia

Materials

► Plastic tube (many different types are available)

► Graduated bougies

Technique

► Dilate the stricture to 15-18 mm with graduated bougies.

► Locate the proximal and distal tumor margins endos-copically.

► Pass the guide wire down the endoscope.

► Remove the endoscope, leaving the guide wire in place.

► Assemble the delivery system (e.g., bougie, tube, and pusher).

► Introduce the delivery system with the tube.

► Advance through the stricture.

► Remove the bougie, pusher, and guide wire.

Principle and Key Characteristics

► Principle: tumor tissue is coagulated with a Nd:YAG laser to restore patency.

► Disadvantage

- Relatively long duration of treatment (up to four weeks)

Indications

► Stricture caused by exophytic tumor growth

► Short strictures in particular

Contraindications

► Luminal narrowing due to extrinsic compression

Materials

Technique

► Advance the endoscope to the stricture.

► Introduce the laser probe, advance it to the stricture.

► Laser the tumor tissue in short bursts.

► Repeat at intervals of several days.

Complications

► Perforation

► Dislodgment

► Tube obstruction

Fig. 4.57 Compression of an implanted stent by tumor growth
Fig. 4.58 Gastroesophageal reflux following stent insertion

Was this article helpful?

0 0

Post a comment