Endoscopic insertion of palliative oesophageal tubes in oesophagogastric neoplasms

Fifty-five patients have undergone fibreoptic endoscopy under diazepam sedation with attempted insertion of a Celestin tube by the Nottingham introducer for an unresectable oesophagogastric malignant stricture. There were 4 perforations in 48 successful intubations (8.3 per cent), 3 patients subsequently dying and the fourth healing spontaneously. There were 4 proximal tube displacements; 3 patients later returned with bolus obstruction. Thirty-five (73 per cent) of the 48 patients who were successfully intubated left hospital with relief of dysphagia for periods ranging from 10 days to 18 months until death (mean 5.5 months). Of the 13 deaths in hospital, 6 occurred as a result of the procedure (mortality rate 12.5 per cent). We conclude that endoscopic insertion of palliative oesophagogastric tubes is relatively safe, simple to perform and could replace surgical introduction. It is technically more difficult in cases of gastric neoplasm involving the cardia.