Endoscopic intubation has traditionally been considered unsuitable as a means of palliating cervical esophageal
carcinomas involving or within 2 cm of the cricopharyngeus sphincter muscle because of the potential problems of
foreign body sensation and proximal
prosthesis migration. We attempted to palliate eight such patients, three of whom had tracheo-
esophageal fistulas by the endoscopic placement of modified Celestin
endoprostheses; the floppy funnel of the
prosthesis was positioned above the cricopharyngeus in the hypopharynx.
Prosthesis placement and
fistula occlusion was possible in all patients. Six patients had a significant long-term improvement in their
dysphagia, managing a semi-solid (5 patients) or liquid diet (1 patient); two patients did not improve, despite accurate
prosthesis placement, because of marked tracheal aspiration. Six patients reported no
foreign body sensation; one patient had minor discomfort, and another moderate throat discomfort. Distal
prosthesis migration occurred in two patients (replaced in 1 patient). Endoscopic intubation of high cervical esophageal
carcinomas with specially modified
endoprostheses is feasible and can provide worthwhile palliation of
dysphagia and symptoms due to a tracheo-
esophageal fistula.
Foreign body sensation and proximal
prosthesis migration did not prove troublesome.