Outcome, survival, and costs in patients undergoing intubation for carcinoma of the esophagus.
BACKGROUND
In this prospective study a consecutive series of 70 patients undergoing insertion of a Wilson-Cook endoprosthesis for palliation of esophageal carcinoma was examined.


METHODS
The tube was inserted endoscopically using intravenous sedation and a pulsion technique.


RESULTS
The patients had a mean (SEM) age of 70.7 (1.5) years and 44 (63%) were men. Two patients died in hospital and 2 died after discharge, giving a procedure-related mortality of 2.8% and a 30-day mortality of 5.7%. Nine patients experienced complications, giving a morbidity rate of 12.8% following the initial procedure. Twenty patients required a second or further procedure. The indications were tube migration in 22 cases, obstruction in 10, and fistula formation in 2 patients. Thirty-day mortality in this group was significantly greater than after a first procedure (7 patients, 20.1%; P <0.05). The median survival following insertion of a Wilson-Cook endoprosthesis was 16 weeks.


CONCLUSIONS
This study describes a safe, effective method for insertion of an endoprosthesis, with a low morbidity and mortality. The average cost for endoscopic insertion of a Wilson-Cook endoprosthesis in this unit is $1,600, and in view of the short median survival in this group of patients, the introduction of costly self-expanding stents is not warranted without demonstrable benefits in a controlled, prospective, randomized clinical trial.
O'Hanlon
D M
DM
Department of Surgical Gastroenterology, Newcastle General Hospital, Newcastle upon Tyne, UK.
Callanan
K
K
Karat
D
D
Crisp
W
W
Griffin
S M
SM
D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality; D004947:Esophagus; D005260:Female; D006801:Humans; D007440:Intubation / Q000009:adverse effects / Q000191:economics; D008297:Male; D010166:Palliative Care; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects / Q000191:economics; D016019:Survival Analysis; D016896:Treatment Outcome