OUTCOME, SURVIVAL, AND COSTS IN PATIENTS UNDERGOING INTUBATION FOR CARCINOMA OF THE ESOPHAGUS

BACKGROUND: In this prospective study a consecutive series of 70 patie nts undergoing insertion of a Wilson-Cook endoprosthesis for palliatio n of esophageal carcinoma was examined, METHODS: The tube was inserted endoscopically using intravenous sedation and a pulsion technique, RE SULTS: The patients had a mean (SEM) age of 70.7 (1.5) years and 44 (6 3%) were men, Two patients died in hospital and 2 died after discharge , giving a procedure-related mortality of 2.8% and a 30-day mortality of 5.7%, Nine patients experienced complications, giving a morbidity r ate of 12.8% following the initial procedure, Twenty patients required a second or further procedure, The indications were tube migration in 22 cases, obstruction in 10, and fistula formation in 2 patients, Thi rty-day mortality in this group was significantly greater than after a first procedure (7 patients, 20.1%; P <0.05), The median survival fol lowing insertion of a Wilson-Cook endoprosthesis was 16 weeks, CONCLUS IONS: This study describes a safe, effective method for insertion of a n endoprosthesis, with a low morbidity and mortality, The average cost for endoscopic insertion of a Wilson-Cook endoprosthesis in this unit is $1,600, and in view of the short median survival in this group of patients, the introduction of costly self-expanding stents is not warr anted without demonstrable benefits in a controlled, prospective, rand omized clinical trial. (C) 1997 by Excerpta Medica, Inc.