Treatment of malignant strictures of the cervical esophagus by endoscopic intubation using modified endoprostheses.
Endoscopic intubation has traditionally been considered unsuitable as a means of palliating cervical esophageal carcinomas involving or within 2 cm of the cricopharyngeus sphincter muscle because of the potential problems of foreign body sensation and proximal prosthesis migration. We attempted to palliate eight such patients, three of whom had tracheo-esophageal fistulas by the endoscopic placement of modified Celestin endoprostheses; the floppy funnel of the prosthesis was positioned above the cricopharyngeus in the hypopharynx. Prosthesis placement and fistula occlusion was possible in all patients. Six patients had a significant long-term improvement in their dysphagia, managing a semi-solid (5 patients) or liquid diet (1 patient); two patients did not improve, despite accurate prosthesis placement, because of marked tracheal aspiration. Six patients reported no foreign body sensation; one patient had minor discomfort, and another moderate throat discomfort. Distal prosthesis migration occurred in two patients (replaced in 1 patient). Endoscopic intubation of high cervical esophageal carcinomas with specially modified endoprostheses is feasible and can provide worthwhile palliation of dysphagia and symptoms due to a tracheo-esophageal fistula. Foreign body sensation and proximal prosthesis migration did not prove troublesome.
Loizou
L A
LA
National Medical Laser Centre, University College Hospital, London, United Kingdom.
Rampton
D
D
Bown
S G
SG
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D010166:Palliative Care / Q000379:methods*; D015607:Stents; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000628:therapy