Palliative treatment of obstructing esophagogastric malignancy by endoscopic positioning of a plastic prosthesis.

Two hundred patients with obstructing esophagogastric malignancy were treated with positioning of a plastic prosthesis. With the aid of a small caliber fiberendoscope and a pusher tube, the prosthesis was positioned under continuous visual control, using only local anesthesia. Seventy-seven patients had esophageal carcinoma, 25 had pulmonary carcinoma obstructing the esophagus, and 98 had gastric carcinoma. Of the latter, 21 had extensive stomach involvement and 8 had local tumor recurrence after esophagojejunostomy. A bronchoesophageal fistula was present in 17 patients. Complications were bleeding (3), perforation (16) with only one death, and obstruction either due to food impaction (13), tumor overgrowth (17), or reflux esophagitis (5); the latter two conditions were corrected by changing the tube in all cases. Tube migration occurred frequently, but could be prevented by adapting the shape of the prosthesis. The procedure was performed as ultimate palliation in patients unfit for surgical insertion and had a low mortality rate of 2%. In general, there was marked improvement in the quality of life.