Palliation of inoperable esophageal tumor with endoscopic intubation

Access to expensive equipment and costly self-expanding metal endoprostheses is limited in some regions where unresectable esophageal cancer is not infrequent. The aim of this study was to review the long-term results of palliation of malignant esophageal obstruction using low-priced conventional plastic stents. 103 patients with dysphagia due to inoperable esophageal cancer underwent esophageal intubation under endoscopic control alone, without general anesthesia, by the pulsion method. Stents mounted on their delivery device were inserted over an endoscopically placed guide wire. Improvement in swallowing was seen in 100%. Dysphagia scores have improved from 3.64+/-0.21 to 1.08+/-0.17. Major early procedure-related morbidity was low (0.6%), with 1 intramural perforation and no transmural perforation at all. Minimal mucosal bleeding was seen with 48 cases (46.6%). Procedure-related mortality was 0%. Late procedure-related complications requiring further endoscopic procedures occurred in 13.5% (tube occlusion: 8.7%, tube dislocation: 4.8%). Our 7 day mortality was 0% and 5 patients had died within 30 days, usually from the disease itself. Those surviving the procedure (>7 days) had a mean survival of 209 days. Esophageal plastic stents can be accurately and safely placed under direct endoscopic control with lower costs. Therefore, endoscopic intubation remains a useful palliative treatment for patients with unresectable carcinoma of the esophagus.