Injection Therapy

A more established, but now less commonly used technique in the palliation of malignant dysphagia is endoscopic injection therapy. The procedure involves the direct injection of a cytotoxic agent into the tumor tissue using an injection catheter. Although 100% ethanol is the most commonly used agent, the successful use of other agents has been reported (eg, 3% polidocanol, 2.5% sodium morrhuate/5-fluorouracil mixture, and cisplatin/epinephrine mixture). In one randomized trial comparing injection with laser ablation, dys-phagia improved in 78% of subjects treated with ethanol, and no significant differences in efficacy or complications were found between the two groups (Carazzone el al, 1999). Complications of alcohol injection include mediastinitis and TEF formation. The extent of resultant tissue necrosis with injection is less predictable than the necrosis associated with the incremental thermal ablative therapies, and many patients require further treatment sessions to sustain symptom relief. Although advantages of the technique include its universal availability and low equipment costs, lack of standardization of the technique and its relatively short efficacy have limited its utility in recent years.

FIGURE 22-3. Endoscopic view of an inoperable esophageal adenocarcinoma before photodynamic therapy for palliation.

FIGURE 22-4. Forty-eight hours after the photodynamic therapy, the luminal diameter is much increased resulting from tumoral necrosis.

FIGURE 22-3. Endoscopic view of an inoperable esophageal adenocarcinoma before photodynamic therapy for palliation.

FIGURE 22-4. Forty-eight hours after the photodynamic therapy, the luminal diameter is much increased resulting from tumoral necrosis.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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