{"id":4075,"date":"2020-05-05T09:00:41","date_gmt":"2020-05-05T09:00:41","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/manejo-endoscopico-no-tratamento-paliativo-de-fistula-traqueoesofagica-de-origem-tumoral\/"},"modified":"2023-08-07T20:53:09","modified_gmt":"2023-08-07T20:53:09","slug":"manejo-endoscopico-no-tratamento-paliativo-de-fistula-traqueoesofagica-de-origem-tumoral","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/manejo-endoscopico-no-tratamento-paliativo-de-fistula-traqueoesofagica-de-origem-tumoral\/","title":{"rendered":"Manejo endosc\u00f3pico no tratamento paliativo de f\u00edstula traqueoesof\u00e1gica de origem tumoral"},"content":{"rendered":"

O c\u00e2ncer de es\u00f4fago \u00e9 frequentemente diagnosticado em um est\u00e1gio avan\u00e7ado e incur\u00e1vel.<\/p>\n

Embora a palia\u00e7\u00e3o cir\u00fargica possa ser considerada em pacientes sem doen\u00e7a metast\u00e1tica e com bom risco operat\u00f3rio, pacientes com risco cir\u00fargico elevado tendem a se beneficiar mais atrav\u00e9s de tratamentos n\u00e3o cir\u00fargicos. Inclusive, com essas abordagens, n\u00e3o raro, apresentam melhora expressiva da disfagia.<\/p>\n

A palia\u00e7\u00e3o desse sintoma pode frequentemente ser alcan\u00e7ada por radia\u00e7\u00e3o, com ou sem quimioterapia associada. No entanto, essa melhora pode ocorrer somente ap\u00f3s v\u00e1rias semanas, fazendo com que por diversas vezes haja comprometimento do quadro cl\u00ednico e complica\u00e7\u00f5es associadas (sangramentos, obstru\u00e7\u00e3o, f\u00edstula esof\u00e1gica, aspira\u00e7\u00e3o, desnutri\u00e7\u00e3o, etc).<\/p>\n

Pacientes sintom\u00e1ticos que n\u00e3o s\u00e3o candidatos \u00e0 radioquimioterapia, aqueles que apresentam disfagia recorrente mesmo ap\u00f3s terap\u00eautica ou naqueles que ocorre certas complica\u00e7\u00f5es (f\u00edstulas por exemplo), podem se beneficiar com tratamentos\u00a0 endosc\u00f3picos paliativos e, embora v\u00e1rios m\u00e9todos endosc\u00f3picos tenham sido descritos, o stent esof\u00e1gico (PMAE –\u00a0pr\u00f3tese met\u00e1lica auto-expans\u00edvel) \u00e9 provavelmente o mais usado .<\/p>\n

Em uma diretriz de 2013, a Sociedade Americana de Endoscopia Gastrointestinal (ASGE) recomendou o implante de stent \u00a0esof\u00e1gico como o m\u00e9todo preferido para palia\u00e7\u00e3o de disfagia em pacientes com f\u00edstulas secund\u00e1rias ao c\u00e2ncer de es\u00f4fago .<\/p>\n

Como regra geral, as abordagens paliativas para o c\u00e2ncer de es\u00f4fago inoper\u00e1vel devem basear-se nas caracter\u00edsticas do paciente, do tumor, nos objetivos do tratamento e nas prefer\u00eancias do paciente e da equipe m\u00e9dica assistente .<\/p>\n

Relato de caso:<\/strong><\/p>\n

Manejo endosc\u00f3pio no\u00a0 tratamento\u00a0 paliativo de f\u00edstula traqueoesof\u00e1gica\u00a0 ap\u00f3s\u00a0 RT e QT.<\/p>\n

Paciente P. S. J. , masculino, 58 anos, de profiss\u00e3o \u201cseresteiro\u201d, tabagista e etilista h\u00e1 mais de 40 anos (SIC) , diagnosticado como portador\u00a0 de\u00a0neoplasia esof\u00e1gica avan\u00e7ada (tumor epiderm\u00f3ide) com comprometimento pulmonar\u00a0 e linfonodal. Foi submetido \u00e0 tratamento sist\u00eamico \u2013 QT e a RT evoluindo com f\u00edstula\u00a0 traqueoesof\u00e1gica a qual impedia a ingest\u00e3o de alimentos.<\/p>\n

Permaneceu com SNE por 2 meses e posteriormente foi realizada uma jejunostomia para manuten\u00e7\u00e3o da nutri\u00e7\u00e3o enteral.<\/p>\n

Ap\u00f3s 4 meses da confec\u00e7\u00e3o do acesso jejunal, foi encaminhado ao servi\u00e7o de endoscopia terap\u00eautica pela equipe oncol\u00f3gica para avalia\u00e7\u00e3o de\u00a0 implante de PMAE.<\/p>\n

A EDA evidenciou ao n\u00edvel do es\u00f4fago tor\u00e1cico, presen\u00e7a de orif\u00edcio grande fistuloso que permitia a n\u00edtida visualiza\u00e7\u00e3o da \u00e1rvore respirat\u00f3ria. N\u00e3o havia estenose associada e a passagem do endosc\u00f3pio para o est\u00f4mago se fazia sem resist\u00eancias.<\/p>\n

Em conjunto com a\u00a0 equipe oncol\u00f3gica, optamos pelo implante de uma\u00a0PMAE parcialmente recoberta.<\/b><\/p>\n

Procedimento terap\u00eautico:<\/b><\/p>\n

EDA \u2013 implante de PMAE<\/strong><\/p>\n

Introduzimos o fio-guia at\u00e9 o duodeno, retiramos o endosc\u00f3pio e, sob radioscopia, liberamos PMAE parcialmente recoberta de 105 mm x 23 mm. A mesma revestiu completamente o orif\u00edcio fistuloso, preservando o es\u00f4fago cervical e a regi\u00e3o da TEG.<\/p>\n

Obs:\u00a0<\/strong>a ingest\u00e3o de l\u00edquidos foi liberada ap\u00f3s\u00a024 horas do implante da PMAE e ap\u00f3s\u00a0 \u00a072 horas foi liberada a ingesta de alimentos s\u00f3lidos.<\/p>\n

Nos primeiros 5 dias queixou-se de dor tor\u00e1cica de leve a moderada intensidade\u00a0a qual respondeu\u00a0 bem a analg\u00e9sicos intravenosos que posteriormente (ap\u00f3s 3 dias) foram administrados pela via oral.<\/p>\n

Paciente recebeu alta hospitalar ap\u00f3s 7 dias do implante (permeneceu internado para t\u00e9rmino do tratamento de pneumonia com antibioticoterapia intravenosa).<\/p>\n

Clique sobre as imagens abaixo para ampli\u00e1-las :<\/strong><\/p>\n

\"\" \"\" \"\" \"\" \"\" \"\" \"\" \"\"<\/p>\n

EDA controle realizada cerca de 3 meses ap\u00f3s a passagem da pr\u00f3tese:<\/strong><\/p>\n

Presen\u00e7a de crescimento tecidual (n\u00e3o tumoral) ao n\u00edvel da extremidade proximal \u00a0(parte n\u00e3o recoberta) do stent o qual n\u00e3o impedia e n\u00e3o dificultava a progress\u00e3o do aparelho.<\/p>\n

Paciente negava epis\u00f3dios de impacta\u00e7\u00e3o alimentar.<\/p>\n

Clique sobre as imagens abaixo para ampli\u00e1-las :<\/strong><\/p>\n

\"\" \"\"<\/p>\n

EDA controle realizada cerca de 6 meses ap\u00f3s a passagem da pr\u00f3tese:<\/strong><\/p>\n

Ap\u00f3s 6 meses do implante do stent apresentou quadro de disfagia progressiva.<\/p>\n

Durante a EDA evidenciamos uma estenose ao n\u00edvel da extremidade proximal da PMAE (crescimento tecidual n\u00e3o tumoral) que n\u00e3o permitia a progress\u00e3o do aparelho.<\/p>\n

Realizamos dilata\u00e7\u00e3o com bal\u00e3o hidrost\u00e1tico sem intercorr\u00eancias.<\/p>\n

Ap\u00f3s o procedimento paciente obteve melhora do quadro disf\u00e1gico.<\/p>\n

Clique sobre as imagens abaixo para ampli\u00e1-las :<\/strong><\/p>\n

\"\" \"\" \"\" \"\" \"\" \"\"<\/p>\n

-Sobrevida de 10 meses\u00a0 ap\u00f3s implante da PMAE devido \u00e0 complica\u00e7\u00f5es causadas por met\u00e1stases.<\/strong><\/em><\/p>\n

Para saber mais sobre este tema<\/a>, acesse o site Gastropedia clicando aqui<\/a>!<\/h3>\n","protected":false},"excerpt":{"rendered":"

O c\u00e2ncer de es\u00f4fago \u00e9 frequentemente diagnosticado em um est\u00e1gio avan\u00e7ado e incur\u00e1vel. Embora…<\/p>\n","protected":false},"author":4257,"featured_media":4076,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[146],"tipo":[153],"volume":[263],"class_list":["post-4075","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-146","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"\nManejo endosc\u00f3pico no tratamento paliativo de f\u00edstula traqueoesof\u00e1gica de origem tumoral • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/manejo-endoscopico-no-tratamento-paliativo-de-fistula-traqueoesofagica-de-origem-tumoral\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Manejo endosc\u00f3pico no tratamento paliativo de f\u00edstula traqueoesof\u00e1gica de origem tumoral\" \/>\n<meta property=\"og:description\" content=\"O c\u00e2ncer de es\u00f4fago \u00e9 frequentemente diagnosticado em um est\u00e1gio avan\u00e7ado e incur\u00e1vel. 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