Electrochemical therapy in palliative treatment of malignant dysphagia: a pilot study

Electrochemical therapy (ECT), a method based on the application of a low-level direct current, was employed in this study to relieve severe dysphagia. In addition, we aimed to assess the efficacy, safety and requirements for follow-up re-interventions.

Sixteen patients with inoperable and circumferential malignant stenosis of the esophagus were palliated by ECT at presentation and then repeatedly whenever tumor growth and dysphagia recurred. The electrode was inserted and placed at the level of stenosis under fluoroscopic guidance, and an electric quantity of 300-560 coulombs (5-6.5 V; 60-90 mA) was given. When total luminal occlusion was found, prior balloon dilatation enabled insertion of the electrode. Patients with squamous cell carcinoma also received external beam radiotherapy of 20-30 Gy in 10 daily fractions. Dysphagia was graded on a scale of O to 4 (O = normal; 4 = complete dysphagia), and follow-up esophagograms were obtained for response evaluation.

The severity of dysphagia decreased by 1-4 (median: 2) grades with an improvement in 6 patients with totally obstructing lesions. Dysphagia recurred in all but 1 patient after a median interval of 10 weeks, but was easily treated with repeat ECT sessions. However, 2 patients became unresponsive to ECT after 7 and 3 months of therapy, respectively. There were no ECT-related complications.

In conclusion, this pilot study suggests that electrochemical therapy may provide safe and effective palliation of narrowing and circumferential esophageal carcinoma. It requires repeat interventions and dilatation expertise is necessary for insertion of the electrode through the totally obstructing lesion.