Endoscopic intubation of oesophago-gastric malignancy

To determine what percentage of inoperable oesophageal and oesophagogastric malignancies could be successfully intubated for palliation, and to compare Atkinson and Celestin tubes.

A consecutive series of 210 patients who had been referred for palliation underwent endoscopy and intubation with the Nottingham introducer.

One hundred and nineteen men and 91 women aged 31-91 (mean age 71) years with inoperable malignant obstruction of the oesophagus or gastro-oesophageal junction were studied. One hundred and five tumours were in the lower third of the oesophagus, 78 in the middle third, 25 in the upper third and seven in the gastric fundus. Four tracheo-oesophageal fistulae resulting from bronchial carcinomas were also successfully intubated. MAJOR OUTCOME MEASURE: Eighty-nine per cent of gastro-oesophageal malignancies were successfully intubated using 120 Atkinson and 67 Celestin tubes.

Eleven patients (5.2%) suffered oesophageal perforations during intubation, of whom six died. Nine of the perforations occurred in the first 100 patients treated but only two (2.3%) in the subsequent 87. Seven patients (3.7%) developed aspiration pneumonia, of whom five died. The mean survival time after intubation was 4.5 months (range 0.5-20 months), and 74% of patients required no further procedure. During follow-up, five (4.2%) Atkinson tubes displaced upwards, compared with 12 (17.9%) Celestin tubes (P < 0.01). Eighteen (9.6%) patients had recurrent dysphagia as a result of bolus obstruction and 11 (5.9%) had tumour overgrowth of the tube.

Palliative intubation of malignant dysphagia is possible in approximately 90% of patients. The mortality associated with the procedure is low (5%) and effective relief of symptoms is achieved, with 74% of patients requiring no further treatment.