Upper GI: Palliative measures - dysphagia and bleeding

Question

An 80-year-old man with metastatic oesophageal adenocarcinoma presents with rapidly progressive dysphagia and is now unable to manage liquids, with significant weight loss. He needs prompt relief to restore swallowing. After a self-expanding metal stent is placed he develops prolonged low-grade bleeding from the tumour. What is the most appropriate next step in management?

Accepted Answer

C) Stent for dysphagia relief, then consider external beam radiotherapy for prolonged bleeding — NICE NG83 recommends offering self-expanding stents to people who need immediate relief of dysphagia. It advises not routinely offering external beam radiotherapy after stenting, but to consider external beam radiotherapy after stenting for people with prolonged post-interventional bleeding, which is exactly this patient's situation.

Answer

A) Routine external beam radiotherapy is strongly and universally recommended as standard care for all patients immediately after stent insertion

Answer

B) Radical chemoradiotherapy with curative intent

Answer

D) Withhold all radiotherapy as it is contraindicated after stenting

Answer

E) Oesophagectomy to control the bleeding