ENDOSCOPIC PALLIATION OF ESOPHAGEAL-CARCINOMA WITH ATKINSON PROSTHESIS

To assess the degree of palliation, the associated morbidity and morta lity and to compare our results with other published series, me review ed our use of the Atkinson prosthesis in 100 consecutive patients for the palliation of unresectable oesophageal carcinoma. The group had a mean age of 71.2 +/- 2.3 years. All prostheses were placed by the puls ion method. Intubation was successful in 91%. Improvement in swallowin g was seen in 82.1%. Major early procedure-related morbidity was high at 23% with 11 perforations (11%). Procedure-related mortality was 12% . Those aged 70 years or more had a 34.5% risk of morbidity and 15.5% risk of dying from the procedure. Late procedure-related complications requiring further endoscopic procedures occurred in 27%. Our 7 day mo rtality was 14.7% (14 patients) and 31 patients (32.6%) had died withi n 30 days, usually from the disease itself. Those surviving the proced ure (> 7 days) had a mean survival of 105 (range 9-735) days. We obtai ned acceptable palliation but with a significant morbidity and mortali ty. Endoscopic intubation remains a useful palliative treatment for pa tients with unresectable carcinoma of the oesophagus and cardia.