Cuffed esophageal prosthesis: a useful device in desperate situations in esophageal malignancy

Sixteen patients (three groups) underwent endoscopic intubation with cuffed Wilson-Cook esophageal endoprostheses. Group 1 comprised 10 patients with spontaneous esophago-respiratory fistulas due to malignancy. Six primaries were esophageal, three bronchial and one ovarian. One patient could not tolerate a cuffed tube. All other fistulas closed with intubation but two tubes displaced later. Seven patients managed a soft diet after intubation, but two liquids only. Median survival was 4 weeks (range, 0 to 9 weeks). Group 2 comprised three patients with large endoscopic instrumental tears. Two had definite perforations with extensive surgical emphysema. All had satisfactory contrast swallows the day after intubation and were started on semi-solid diets; median survival was 10 weeks (one still alive). Group 3 included three patients with life-threatening arterial bleeding from cancers of the gastric cardia. No further bleeding occurred in any of the three after intubation and two survived for extended periods (15 and 26 weeks). Cuffed tubes are invaluable in these desperate situations and are worth considering for symptomatic relief even when prognosis is short.