Endoscopic palliation of cancer of the cervical esophagus

Whether to palliate dysphagia in patients with inoperable cancer of the cervical esophagus is a debatable issue. Out of 159 patients with inoperable esophageal and cardia cancers who underwent endoscopic palliation in our department in the last 3 years, 23 (14.5%) presented with a stricture located in the cervical esophagus. Four patients had previously undergone laryngectomy. A traditional or self-expanding stent was positioned in 13 patients (56.5%) with a normal swallow capability and with an infiltrating stricture, also located at the level of the upper esophageal sphincter. Neodymium: yttrium-aluminium-garnet laser therapy and intratumoral ethanol injection were used in 3 and 1 patient (17.4%), respectively, with a predominantly fungating stricture located within 2 cm from the upper esophageal sphincter. A percutaneous endoscopic gastrostomy was performed in the remaining 6 patients (26.1%) in whom the placement of a stent or neodymium: yttrium-aluminium-garnet laser therapy was technically impossible. No mortality related to the procedures has been recorded. Oral feeding improved in all patients but one who underwent esophageal stenting, and in all 4 patients who were treated with laser or injective therapy. It can be concluded that an endoscopic palliative treatment can be successfully performed even in most of the patients with cervical esophageal stricture. Self-expanding stents significantly improved the possibilities of intubation allowing a low-risk placement of a stent even in patients with a stricture involving the upper esophageal sphincter in whom the positioning of a traditional tube is at high risk or technically impossible.