Palliative endoscopic management of obstructive esophagogastric cancer: laser or prosthesis?

One hundred forty-four patients with unresectable malignant strictures of the upper digestive tract were managed by palliative endoscopic methods: 116 by intubation and 28 by YAG laser phototherapy. The success rate was 95% for intubation and 100% for laser. The morbidity rate was 13.8% for intubation (perforation 7.8%, bleeding 3.4%, and aspiration pneumonia 2.2%) and 3.6% (one perforation) for laser. The mortality rate was 4.3% for intubation and 0% for laser. Specific indications for intubation were esobronchial fistulas, extensive strictures, and very long stenotic lesions. Very high cervical strictures and nonocclusive asymmetrical tumors were better treated with laser. In select cases, combined therapy can be useful. We conclude that both methods are highly efficient in restoring patency and relieving dysphagia. Further large scale randomized trials are necessary to compare functional results and survival rate.     

Cuffed esophageal prosthesis: a useful device in desperate situations in esophageal malignancy.

Sixteen patients (three groups) underwent endoscopic intubation with cuffed Wilson-Cook esophageal endoprostheses. Group 1 comprised 10 patients with spontaneous esophago-respiratory fistulas due to malignancy. Six primaries were esophageal, three bronchial and one ovarian. One patient could not tolerate a cuffed tube. All other fistulas closed with intubation but two tubes displaced later. Seven patients managed a soft diet after intubation, but two liquids only. Median survival was 4 weeks (range, 0 to 9 weeks). Group 2 comprised three patients with large endoscopic instrumental tears. Two had definite perforations with extensive surgical emphysema. All had satisfactory contrast swallows the day after intubation and were started on semi-solid diets; median survival was 10 weeks (one still alive). Group 3 included three patients with life-threatening arterial bleeding from cancers of the gastric cardia. No further bleeding occurred in any of the three after intubation and two survived for extended periods (15 and 26 weeks). Cuffed tubes are invaluable in these desperate situations and are worth considering for symptomatic relief even when prognosis is short.     

经皮内镜下胃造口空肠置管术在良性食管瘘患者中的应用

目的研究经皮内镜下胃造口空肠置管术(PEJ)在良性食管瘘患者中应用的可行性、疗效和并发症。方法观察18例良性食管瘘患者接受PEJ的置管时间、成功率、并发症和导管留置时间。结果平均置管时间为(21.75±5.9)min,成功率为94.44%,未发生置管相关性并发症,置管后并发症的发生率为11.11%,平均导管留置时间为(76.88±21.13)d。结论 PEJ是一项安全有效的治疗方法,具有操作简便、快捷、易于护理、患者痛苦少、易于耐受等优点,适合良性食管瘘患者应用。     

自体皮片移植术预防食管环周早癌内镜黏膜下隧道剥离术后食管狭窄的临床研究

目的 评价自体皮片移植术预防食管环周早癌内镜黏膜下隧道剥离术（ESTD）后食管狭窄的安全性和有效性。方法 2018年1月至2018年3月,5例食管环周早癌患者于解放军总医院接受ESTD联合自体皮片移植术。术后通过内镜随访,观察皮片生长情况,有无食管狭窄及并发症发生情况。结果 5例患者均成功实施了食管环周早癌ESTD和自体皮片移植术。无食管穿孔、出血、创面感染和支架移位等并发症发生。平均移植皮片成活率为86.0%。4例患者术后平均随访9.5个月,未发生食管狭窄;1例患者术后发生食管狭窄并进行了球囊扩张,术后随访8个月内未再发生狭窄。结论 自体皮片移植术可能是预防食管环周早癌ESTD术后食管狭窄的一种安全且有效的方法。     

Sclerotherapy for esophageal variceal bleeding in advanced hepatocellular carcinoma: An 8-year experience in Taiwan

Between August 1983 and December 1991 at the Taichung Veterans General Hospital, Taiwan, 65 advanced hepatocellular carcinoma (HCC) patients with esophageal variceal bleeding received endoscopic injection sclerotherapy (EIS) and 60 such patients received conservative medical treatment without EIS. The rate of successful control of acute bleeding was 72.5% (27/40 patients) in the EIS group and 56.7% (34/60 patients) in the non-EIS group. The rebleeding rate was lower in the EIS group than in the non-EIS group (26.9% vs 73.5%). Thirty-one of the EIS and 44 of the non-EIS treatment patients, mainly Child's B and C patients, died within 2 months after the first bleeding. In the short term, EIS decreased the mortality due to esophageal variceal bleeding, but the survivors still had to face hepatic failure and tumor growth. Thus, benefits of EIS were noted on short-but not on long-term survival. The mean survival times were 2.38 months for the EIS group and 1.79 months for the non-EIS group. Since EIS had no beneficial effects on long-term survival it is doubtful whether sclerotherapy applied to esophageal variceal bleeding in patients with advanced HCC would be worthwhile, as the endoscopic procedure would only add to their suffering.     

Natural course of inoperable esophageal cancer treated with metallic expandable stents: quality of life and cost-effectiveness analysis

BACKGROUND AND AIM: The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with self-expanding metallic endoprostheses in the management of malignant esophageal obstruction or stenosis and the cost-effectiveness of the method in patients suffering from primary esophageal carcinoma. All patients with inoperable esophageal cancers treated with either laser palliation or endoprosthesis insertion were studied retrospectively. METHOD: Between May 1997 and December 2002 obstruction of the esophagus was diagnosed in 78 patients (52 male, 26 female, age range 53-102 years, mean 72.3 years). The etiology of obstruction was squamous cell carcinoma (n = 42) and adenocarcinoma of the esophagus (n = 36). The site of obstruction was in the upper (n = 1), in the middle (n = 38) and in the lower esophagus (n = 39). In 16 cases the gastroesophageal junction was also involved. Four patients had broncho-esophageal fistulas. In all cases the tumor was considered non-resectable. A total of 89 Ultraflex metal stents were introduced endoscopically. In 46 patients dilation with Savary dilators prior to stent placement was required. RESULTS: Stents were placed successfully in all patients. After 48 h, all patients were able to tolerate solid or semisolid food. During the follow-up period eight patients developed dysphagia due to food impaction (treated successfully endoscopically). Eleven patients presented with recurrent dysphagia 4-16 weeks after stenting due to tumor overgrowth and were treated with placement of a second stent. The median survival time was 18 weeks. There was no survival difference between squamous cell and esophageal adenocarcinoma. A cost-effective analysis was performed, comparing esophageal stenting with laser therapy. The mean survival and the cost were similar. A small difference of 156 Euro was noted (3.103 Euro and 2.947 Euro for each group of patients, respectively). A significant improvement in quality of life was noted in patients that underwent stenting (96% and 75%vs 71% and 57% for the first 2 months). CONCLUSION: Placement of self-expanding metal stents is a safe and cost effective treatment modality that improve the quality of life, as compared with other palliative techniques, for patients with inoperable malignant esophageal obstructions. In cases of expansion of the mass a second stent can be used; however, the overall survival of these patients, is poor.     

Esophageal carcinoma and achalasia: prevalence, incidence and results of treatment.

Between 1980 and 1988, we treated 1,521 patients with squamous cell carcinoma of the esophagus and 336 patients with adenocarcinoma of the gastric cardia. Between 1967 and 1988, 244 patients with esophageal achalasia were also observed. Among 1,857 patients with cancer, achalasia was present in 21 cases (1.1%). In 18 patients the mean and median interval between the diagnosis of achalasia and cancer was 11.5 and 8 years, respectively. In 3 cases achalasia was detected during the work-up for esophageal cancer. The previous treatment for achalasia administered elsewhere was as follows: balloon dilatation in 6 cases, myotomy and Nissen repair in 2, and distal esophageal resection in 1. Thirteen patients (61.9%) underwent resection, resulting in 1 postoperative death, and a mean and median survival of 23.3 and 13 months, respectively. Push intubation was performed in 4 cases, chemotherapy in 2, a by-pass procedure in 1, endoscopic Nd:YAG laser in 1, while 1 further patient did not receive any treatment for the carcinoma, but only balloon dilatation of the LES. The mean follow-up of the 244 patients with primary esophageal achalasia was 44.6 months (range 1-108), and only 1 patient developed an esophageal cancer, giving an incidence of 18.6 cases per 100,000 per year. Conclusions: in our experience, achalasia is present in a minority of patients with esophageal cancer, and larger prospective controlled trials are needed to assess the true incidence of malignant degeneration in the achalasic patient.     

Endoscopic palliation of malignant dysphagia.

In patients with obstructive tumors of the esophagus and who cannot undergo curative surgery, endoscopic palliative methods can provide a quick relief of dysphagia with subsequent improvement of nutritional status. The technical success rate is as high as 95% for intubation and 100% for laser therapy. Both methods have their specific indications. Intubation is often able to provide quick and definitive palliation while laser therapy requires several sessions and relapses of obstruction are frequent. On the other hand, intubation carries a high risk of perforation (8.7%), and laser appears to be safer (1.7% perforation). Both methods can be combined in many instances, and their association with afterloading or external beam radiation therapy can be beneficial. Even if the overall survival rate is only 6 to 7 months, the improvement of the quality of life is the priority goal of these methods.     

Endoscopic Intubation with Conventional Plastic Stents: A Safe and Cost-Effective Palliation for Inoperable Esophageal Cancer

Access to expensive equipment and costly self-expanding metal endoprostheses is limited in some regions where unresectable esophageal cancer is not infrequent. The aim of this study was to review the long-term results of palliation of malignant esophageal obstruction using low-priced conventional plastic stents. One hundred sixty-nine patients with dysphagia due to inoperable esophageal cancer underwent esophageal intubation under endoscopic control alone, without general anesthesia, by the pulsion method. Stents mounted on their delivery device were inserted over an endoscopically placed guide wire. Improvement in swallowing was seen in all patients. Dysphagia scores have improved from 3.64 +/- 0.21 to 1.08 +/- 0.17. Major early procedure-related morbidity was high at 0.6% with one intramural perforation (no transmural perforation at all). Minimal mucosal bleeding was seen with 72 cases (42.6%). Procedure-related mortality was 0%. Late procedure-related complications requiring further endoscopic procedures occurred in 8.2% (tube occlusion: 5.3%, tube dislocation: 2.9%). Our 7-day mortality was 0% and 5 patients died within 30 days, usually from the disease itself. Those surviving the procedure (more than 7 days) had a mean survival of 209 days. Esophageal plastic stents can be accurately and safely placed under direct endoscopic control with lower costs. Therefore, endoscopic intubation remains a useful palliative treatment for patients with unresectable carcinoma of the esophagus.     

Results of sclerotherapy for bleeding esophageal varices in patients with schistosomal liver disease. A retrospective study

BACKGROUND/AIMS: The aims of the study were to evaluate results of injection sclerotherapy in patients with liver schistosomiasis inducing bleeding esophageal varices and to review ultrasonographic features of the liver disease as well as endoscopic characteristics of the esophageal disease in order to assess any interrelationship between them. METHODOLOGY: A total of 34 patients with active or recent history of hematemesis and Schistosoma mansoni infection had emergency or elective endoscopic sclerotherapy. Each underwent ultrasound examination to assess hepatosplenic involvement and staging, and were followed-up with upper digestive endoscopy every 4 months. RESULTS: Obliteration or reduction of the varices in small columns was achieved in 82.3% of cases. During the follow-up period (mean: 10.4 +/- 2.1 months; range: 4-16 months) rebleeding was noted in 2 patients and 2 patients died due to variceal hemorrhage. The relationship between the ultrasonographic periportal fibrosis grade and the endoscopic variceal grade or varices localization was very strong (P < 0.001). A significant difference between grade 1 vs. 3 and 1 vs. 2 of periportal fibrosis and the presence of red signs was also found (P < 0.008). CONCLUSIONS: In view of the results obtained in terms of success rate in obliterating varices, rebleeding and mortality rates, a longitudinal study could be justified to assess the usefulness of prophylactic sclerotherapy for the prevention of the first variceal hemorrhage and in the attempt to prolong survival in patients with Schistosoma-induced esophageal varices.     

Efficacy of Endoscopic Prosthesis in T4 Cancer of the Intrathoracic Esophagus

No remarkable improvement has yet been achieved in the survival of patients with advanced intrathoracic esophageal cancer. In particular, patients with complications such as esophago-bronchial fistula or invasion into the mediastinum have an especially miserable prognosis, even with surgical treatment. To improve the quality of life (QOL) of such patients, extensive palliative therapy should be provided. Thus, we have introduced an endoscopic esophageal intubation technique for the treatment of stenosis or perforation in patients with T4 esophageal cancer. Nine patients with unresectable intrathoracic esophageal cancer, complicated by stenosis or perforation, were treated with an endoscopic esophageal prosthesis. Four cases had an esophago-bronchial fistula, and in three the tumor had perforated the mediastinum. The prosthesis was successfully placed under endoscopic guidance in all nine cases. Six patients (66.7%) subsequently resumed oral intake without discomfort, while two had reasonably good outcomes in this regard (efficacy rate; 88.9%). Complications were seen in three patients: mainly chest discomfort, reflux esophagitis and migration of the prosthesis in one patient each. Six patients required prolonged administration of chemotherapeutic agents following prosthesis placement. Mean survival was 123.4±77.0 days. Four of the nine patients died in the hospital. Palliative endoscopic esophageal prosthesis was considered to be useful for patients with advanced esophageal cancer. With this technique, an improvement in QOL was achieved, as sufficient oral intake was facilitated and pulmonary and mediastinal complications due to perforation were diminished.     

Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth II gastrectomy

AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP attempts.In all cases,the ERCP procedures were started using a duodenoscope.If intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success rate.RESULTS:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent DBE-ERCP.The DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully treated.One patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by biopsy.There were no complications related to the DBE.The overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.     

Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes

Background and Aims

Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment.

Methods

Multicentre retrospective study.

Results

We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients.

Conclusion

This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.

     

食管癌高发区Barrett食管检出率和P53的表达

了解食管癌高发区Ｂａｒｒｅｔｔ＇ｓ食管（ＢＥ）的患病率及ＢＥ与食管腺癌的关系。对３３１例河南省食管癌高发区农村自然人群进行了Ｂａｒｒｅｔ＇ｓ食管的内镜普查和病理组织学检查。同时对１４例来自门诊的Ｂａｒｒｅｔｔ＇ｓ食管病人的活检标本，用免疫组织化学染色的方法检测了抗癌基因Ｐ_（５３）的表达。结果显示：该人群Ｂａｒｒｅｔｔ＇ｓ食管患病率为０．９１％，返流性食管炎的检出率为７．６％。抗癌基因Ｐ_（５３）在１４例Ｂａｒｒｅｔｔ＇ｓ食管标本中阳性表达率为４２％。其中５０％阳性表达的标本伴有不典型增生。Ｐ_（５３）阳性表达可能是Ｂａｒｒｅｔｔ＇ｓ食管上皮到食管腺癌发生过程中一个极早期的改变。对Ｂａｒｒｅｔｔ＇ｓ食管伴有不典型增生或肿瘤基因表达阳性者应视为高危人群，对他们进行重点预防和阻断治疗是必要的。     

Management of anastomotic biliary stricture after liver transplantation and impact on survival

BackgroundAnastomotic biliary strictures (AS) is the main surgical complication after liver transplantation. The aims of this study are to investigate the risk factors of AS, its management and its impact on overall survival and survival of the graft.MethodsAll patients who had received a liver transplantation with duct-to-duct anastomosis at Toulouse University Hospital between 2010 and 2016 were included.ResultsOf 225 included patients, 56 (24.9%) presented with AS. The median time to discovery of AS was 83 days and 69.6% of the AS appeared within 6 months. Transplantation in critically ill patients, with a liver score >800 points, was an independent predictive factor of survival (P = 0.003). The first-line treatment was endoscopic (87.5%), with a success rate of 79.6% and a median of 4 procedures per patient in 12 months. In cases of failure of endoscopic therapy, percutaneous treatment had a high failure rate (50%). AS had no impact in terms of overall survival or in terms of graft survival.ConclusionAS do not have any repercussions on patient or graft survival, requiring long endoscopic treatment with multiple procedures. In the event of failure of this first-line endoscopic treatment, it seems preferable to turn directly towards surgical repair.     

Esophageal variceal ligation for acute variceal bleeding: results of three years' follow-up.

BACKGROUND/AIMS: Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. However, the rebleeding course and long-term outcome of patients with esophageal variceal hemorrhage after ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation. METHODS: Twenty-one liver cirrhotic patients with endoscopically proven esophageal variceal hemorrhage were treated by endoscopic variceal ligation. These patients received regular follow-up and detailed clinical assessment of at least 24 months. RESULTS: Twenty-one eligible patients were followed up for a mean of 44.45 months (range 33.5-64 months). The mean number of sessions required to obtain eradication was 3.57+/-1.99 (range 1-8). Esophageal varices could be obliterated within 11.57+/-6.8 weeks (range 3-30). The percentage of variceal recurrence during follow-up was 57.14% (12/21) after endoscopic variceal ligation. Recurrence were observed in a mean of 34 months (median 29 months). Rebleeding from esophageal varices appeared in four patients (19.04%). The appearance rates of portal hypertensive gastropathy and fundal gastric varices after varice obliteration were found to be 45.45% (5/11) and 25% (3/12), respectively. CONCLUSIONS: Based on the results of long-term follow-up of endoscopic variceal ligation, although the percentage of variceal recurrence was high, endoscopic ligation achieved variceal obliteration faster and in fewer treatment sessions. Furthermore, endoscopic variceal ligation had a lower rate of rebleeding and of development of fundal gastric varices, but high portal hypertensive gastropathy.     

可拆出机织型捆绑式食管支架预防碱烧伤食管疤痕狭窄

目的 :研究置入可拆出机织型捆绑式食管支架能否预防和治疗碱烧伤所致的腐蚀性食管炎疤痕狭窄。方法 :2 4例消化道碱烧伤患者 ,经食管扩张后置入可拆出机织型捆绑式食管支架 ,4周后拆除食管支架 ,每 3个月定期随访患者的症状及胃镜检查。结果 :支架置入成功率 10 0 % ,2 0例患者能进食普食 ,4例进食半流 ,4周后拆除食管支架 ,当时显效 2 0例 ,有效 4例 ,总有效率 10 0 % ,随访观察 18～ 2 4个月 ,随访结果用Kaplan Meier法统计分析 ,发现只有大约 30 %的患者在日后需要行食管扩张治疗 ,其中大部分是发生在拆除食管支架后的 12～ 18个月。结论 :置入可拆出机织型捆绑式食管支架可预防和治疗碱烧伤后食管疤痕狭窄 ,与单纯食管扩张疗法比较 ,可明显减少患者术后再次进行食管扩张治疗的发生率。     

Improved long-term survival following complete eradication of esophageal varices by sclerotherapy

BACKGROUND/AIMS: Conflicting results have been reported concerning the effect of endoscopic injection sclerotherapy upon the long-term survival of cirrhotic patients with esophageal varix. The recurrence and rebleeding of esophageal varices seems to be an important factor influencing long-term survival. We investigated the long-term survival of patients after complete eradication of esophageal varices. METHODOLOGY: Forty patients treated by endoscopic injection sclerotherapy for acute esophageal variceal bleeding were studied. The recurrence rate of varices and the long-term survival of patients in whom complete eradication of esophageal varices was obtained were compared with those of patients in whom the eradication of varices was incomplete. RESULTS: The frequency of the recurrence/deterioration rate of varices and rebleeding in the complete eradication group was significantly lower than that in the incomplete eradication group (10.7% vs. 100%, 0% vs. 58.3%, respectively, p < 0.01). Accumulated 5-year survival rate of the complete eradication group was significantly higher than that of the incomplete eradication group (68.2% vs. 43.2%, p < 0.05). CONCLUSIONS: Complete eradication of esophageal varices by endoscopic injection sclerotherapy is effective both in preventing variceal re-bleeding and in improving the survival of cirrhotic patients with esophageal varices.     

The Significance of Endoscopically Placed Prostheses in the Management of Biliary Obstruction Due to Carcinoma of the Pancreas: Results of Nonoperative Decompression in 277 Patients

Nonoperative methods for decompressing the biliary tree obstructed by tumor offer viable alternatives to the use of surgery alone to palliate jaundice, pruritus, and impending cholangitis. Published data indicate that biliary drainage through endoscopic means may be superior to the percutaneous route, both being superior to surgical palliation in patients with unresectable pancreatic adenocarcinoma. We have inserted endoprostheses in 277 patients with carcinoma of the pancreas with a success rate of 89%. Eighteen percent of the patients were deceased in 30 days, however, there was no procedure related surgery or death. These results were achieved with a complication rate of only 21% (major = 4%). The occlusion rate was found to be 30% in 3 months. Patients were hospitalized for a mean of 3.5 days with a mean survival of 129 days. The advantages of endoscopic biliary drainage are as follows: low procedure related mortality, low incidence of major complications, and short hospital stay. In conclusion, given the short mean survival of patients with unresectable malignant biliary obstruction, nonsurgical decompression should be considered as primary treatment.     

What does radiotherapy add to survival over endoscopic intubation alone in inoperable squamous cell oesophageal cancer?

The place of radiotherapy in the management of squamous cell oesophageal cancer remains uncertain. Survival of oesophageal cancer patients from the Nottingham area in the years 1982-5 was reviewed. Surgical resection was attempted in 44 of 131 patients with squamous cell oesophageal cancer. Among the remainder 32 had endoscopic intubation alone, 27 had radical radiotherapy alone (six) or combined with endoscopic intubation (21), and 28 had other treatment combinations including surgical intubation and palliative radiotherapy. Patients treated by intubation alone had a mean age of 75 years. They were significantly older and metastases were more common (31%) in this group than in patients treated with radiotherapy (mean age 69 years), of whom 11% had metastases. Some 34% (11 of 32) of patients treated by intubation alone died within 30 days of diagnosis and were therefore not eligible for radiotherapy. Beyond 30 days, survival in the radiotherapy group (median survival 188 days; 95% confidence limits 133-253) was not significantly greater than that for the group treated by intubation alone (median survival 98 days (73-154)). The radiotherapy patients had a median hospital stay of 46 days compared with 23 days for the patients treated by intubation alone. In patients with squamous cell oesophageal cancer unsuitable for surgery, the survival advantage associated with radiotherapy and intubation is small and does not compensate for the extra morbidity and prolonged hospital stay. A controlled trial of radiotherapy in these patients is now needed.