Objective The palliation of dysphagia in metastatic esophageal cancer remains a challenge ,and the optimal approach for this difficult clinical scenario is not clear .We therefore sought to define and determine the efficacy of various treatment options used at our institution for this condition .Methods Methods We reviewed a prospective database for all patients managed in an e-sophageal cancer referral centre over a 5-year period .All patients receiving palliation of malignant dysphagia were reviewed for de-mographics ,palliative treatment modalities ,complications ,and dysphagia scores (0= none to 4= complete) .The Wilcoxon signed rank test was used to determine significance (P<0 .05) .Results During 2005~2010 ,80 patients with inoperable esophageal cancer were treated for palliation of dysphagia .The primary treatment was radiotherapy in 66% ,metal stenting in 21% and radiotherapy combined with stent in 13% .Mean duration of treatment was 1 day in he stent group and 40 days in the radiotherapy group(P=0 . 001) .In patients treated initially by stenting ,dysphagia improved within 2 weeks of treatment in 82% of patients(dysphagia score of 0 or 1) .However ,18% of patients presented with recurrence of dysphagia at 10 weeks of treatment .In the radiotherapy group , the onset of palliation was slower ,with only 50% of patients palliated at 2 weeks(dysphagia score of 0 or 1) .However ,long-term palliation was more satisfactory ,with 90% of patients remaining palliated after 10 weeks of treatment .Conclusion In inoperable e-sophageal cancer at our centre ,radiation treatment provided durable long-term relief ,but came at a high price of a long wait time for initiation of treatment and a long lag time between initiation of treatment and relief of symptoms .On the other hand ,stenting pro-vided more rapid and effective early relief from symptoms ,but was affected by recurrence of dysphagia in the long-term .

Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.