A new approach to the management of malignant esophageal obstruction and esophagorespiratory fistula

Successful palliation of 6 patients with total or nearly total malignant esophageal obstruction is reported. In 5 of the patients, laser vaporization, dilation, and placement of an endoesophageal prosthesis resulted in an esophageal lumen that allowed adequate swallowing of soft food. In 1 patient with an esophagorespiratory fistula, the prosthesis successfully occluded the fistula and prevented aspiration or pulmonary infection until the patient's death. This rapidly achieved endoscopic palliation represents a major advance in the management of a serious medical problem.