[Atkinson prosthesis in esophageal carcinoma. Radiologic study: when CT?]

The endoscopic palliative treatment of esophageal and esophagocardial neoplastic stenoses is generally performed in the patients in whom surgery is not indicated for oncological and general reasons and endoscopic dilatation is uneffective. Our experience is reported concerning 92 patients submitted to palliative therapy through placement of Atkinson prostheses; the patients underwent radiologic studies--i.e. (a) plain chest radiographs (before and after intubation), (b) esophagogastric studies with iodate cm, and (c) CT (performed in the last 20 cases only). The mortality rate at 30 days was 6.5% (6 cases), in no case due to specific complications related to intubation. The mean survival was 3.6 months (range: 1-12). As to the complications specifically related to intubation, they were basically 3: perforation, dislocation, and obstruction (of the prosthesis). As to the methods allowing best demonstration of the same: a) CT proved to be superior in revealing perforation, which usually occurs early after intubation. However, considering its low incidence (2 cases only, in our series), the routinary use of CT does not seem justified. CT should be reserved to selected patients in whom the shape of the neoplasm or peculiar anatomical conditions make intubation difficult, with high risks of perforation--e.g., kiphoscoliosis, hiatal hernia, previous surgery or radiotherapy, angulation of the prosthesis, neoplasm of scirrhous or necrotic type or causing luminal deviation; b) if dislocation occurs, as it more often happens (9 cases in our series) in the presence of soft neoplastic tissue or in cases of mild or asymmetrical stenosis, CT seems likewise unnecessary. Conventional radiology proved superior thanks to its more comprehensive view, and therefore sufficient to suggest the correct treatment--e.g. repositioning of the prosthesis by means of fiberoscopy, or withdrawal after gastrostomy; c) CT appeared useless in the cases due to alimentary causes (easily detectable from the clinical history), but proved useful in the cases due to neoplastic overgrowth. In the latter, CT can yield information as to the site and size of the neoplasm, as well as to its relationship to surrounding tissues, and thus help suggest proper treatment--e.g. dilatation and repositioning of the prosthesis, gastrostomy, recanalization by means of NdYAG laser, no treatment at all.