Endoscopic placement of esophageal prostheses for inoperable carcinoma of esophagus.

In Pakistan, carcinoma of the esophagus ranks as the 5th commonest tumour in females and 9th in males. At our centre we see about 20-25 cases of malignant dysphagia each year. In most, the etiology is squamous cell carcinoma with only 2% occurrence of adenocarcinoma secondary to Barrett’s esophagus. Though surgical results with transhiatal esophagectomy have improved over the past decade with better resection rate and reduced in hospital mortality; but surgery most of the time provides palliation and patients ultimately die of the disease. For sick patients with advanced disease, recanalization of the esophagus or intubation is the treatment option. The easiest way to produce a satisfactory lumen is through intubation with a plastic Atkinson-type tube, using ultrasound guidance under intravenous sedation. Esophageal perforation as a result of dilatation of esophagus prior to protheses placement is a major complication. Other options are self expanding metal stent and NdYAG laser, argon beam photocoagulation and injection of absolute alcohol for recanalization of esophagus. We present our experience of esophageal intubation using Wilson and Cook’s prostheses which is a modified Atkinson prostheses.