Peroral pulsion intubation of malignant esophageal strictures using a fiberoptic technique

Palliative peroral pulsion intubation of malignant esophageal strictures in 44 patients with incapacitating dysphagia is reviewed. Intubation, using a fiberoptic endoscope, the Nottingham® introducer, and a modified Celestin® tube was performed, usually under intravenous sedation. Intubation was successful in 93 per cent and provided satisfactory relief of dysphagia. Six deaths (14%) were the result of intubation, three from esophageal perforation, two from aspiration pneumonia, and one from hemorrhage. The overall hospital mortality was 23 per cent. Six patients required reintubation for proximal or distal migration of the prosthesis. Although mean survival was short (3.2 months) esophageal intubation by this technique is relatively safe, minimizes hospitalization, and offers reasonable palliation in most patients.