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Ann Thorac Surg 1996;62:961-962
© 1996 The Society of Thoracic Surgeons

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Editorials

Keeping an Open Mind While Restoring Esophageal Patency in Patients With Cancer and Esophagorespiratory Fistula

Virginia Mason Medical Center, Seattle, Washington

The first 20% of the full text of this article appears below.

Successful management of patients with malignant, incurable esophageal obstruction should be safe and effective treatment that is both time and cost efficient. Radiation, both external beam and brachytherapy, and chemotherapy are options that may be applicable after the relief of the acute obstructive process. However, the prerequisite delay in the resumption of oral nutrition and the ability to manage salivary secretions requires techniques that produce immediate results.

Repeated bouginage can provide immediate improvement in swallowing but usually requires frequent repeat treatments. Laser therapy has a proven track record with respect to acute palliation of malignant obstruction but requires expensive equipment and multiple treatments with both complication rates and outcomes highly dependent on the skill and experience of the laser endoscopist. As a result, the vast majority of people with malignant esophageal obstruction are currently managed with a variety of endoscopic and fluoroscopically inserted esophageal prostheses.

See also 963.

The history of esophageal stenting originates with the surgically placed stents such as the Celestin tube. These stents now see limited application due to the development of nonoperatively placed stents and unacceptably high in-hospital mortality rates [1]. Conventional pulsion stents such as the Atkinson tube (Key Med, Inc, New Hyde Park, NY) and the coiled polyvinyl prosthesis (Wilson-Cook, Inc, Winston-Salem, NC) have seen wide application, and successful palliation has been achieved in more than 90% of cases in some series [2]. However, complications including bleeding, tracheal compression, prosthesis occlusion, and migration in up to 50% of cases [3], and perforation and procedure-related mortality . . . [Full Text of this Article]

This article has been cited by other articles:

				M. De Groot, D. W. O. Moores, and R. Ilves Expandable Stents in Esophageal Malignancy Ann. Thorac. Surg., July 1, 1997; 64(1): 287 - 288. [Full Text]