Endoscopic palliation of cancer of cervical esophagus

Palliation of malignant dysphagia for cancer of the cervical esophagus remains a challenging problem. Out of 199 patients with inoperable esophageal and cardia cancers who underwent endoscopic palliation in our Department between 1992 and 1996, 31 (15.5%) presented with a stricture located in the cervical esophagus. Four patients had previously undergone laryngectomy. A self expanding Ultraflex stent and a traditional Wilson Cook prosthesis with a shortened funnel was positioned in 9(29.0%) and 7(22.5%) patients with an infiltrating stricture, respectively. Self-expanding stent were positioned with the cranial margin even at the level of the upper esophageal sphincter (UES) only in presence of normal laryngeal motility: traditional tubes were used in laryngectomized patients or when there were at least 2 cm between the cranial margin of the stricture and the UES. Nd:Yag lasertherapy and intratumoral ethanol injection were used in 4(12.9%) and 1(3.2%) patient, respectively, with a predominantly fungating stricture. A percutaneous endoscopic gastrostomy (PEG) was performed in the remaining 10(32.2%) patients in pre-terminal general condition or with extensive malignant infiltration of the hypopharynx. No mortality related to the procedures has been recorded. Hospital morbidity of the 16 patients who underwent intubation or stenting included I aspiration pneumonia. 1 incomplete expansion of a self-expanding stent and 1 intolerance to a Wilson Cook tube. No morbidity was recorded in the patients who underwent lasertherapy or PEG. Out of the 16 patients undergoing esophageal stenting, dysphagia improved of at least 2 degrees allowing a soft and a liquid diet in 11 and 4 patients, respectively. In the last patient dysphagia persisted unchanged. A soft diet was possible in the 5 patients who underwent lasertherapy or intratumoral ethanol injection. Oral feeding was never attempted in the patients who underwent PEG. Median survival was 5.5 months for the patients treated with esophageal stenting, 4 months for the laser and injective therapies, and I month for the PEG. 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 UES in whom the positioning of a traditional tube is at high risk or technically impossible.