[Palliative surgical therapy of incurable esophagus cancer by stomach bypass and endotube].

Palliative treatment plays an important role in the management of esophageal carcinoma. On the whole there are more than 50% of the patients where the tumour is already inoperable at the time of diagnosis. From 1977 to 1983 we treated a total of 132 patients affected with esophageal carcinoma. It was only in 44 patients that the tumour could be resected. In 26 cases the approach was thoraco-abdominal, in 18 patients thoracotomy was unnecessary. Only palliative measures were possible for the rest. In recent years we have favoured gastric bypass or endoscopically and radiologically guided intubation for palliative treatment of esophageal carcinomas. In 17 patients a Celestin tube was placed surgically. During the last 2 years we exclusively inserted the tube endoscopically using the Nottingham introducer (n = 32). According to our results the best palliative treatment could be achieved by gastric bypass, restoring normal swallowing. Only 1 of 16 patients died postoperatively. Endoscopic insertion of an esophageal tube should be considered as a second choice treatment. A review of our mortality statistics and complication rate suggest that the Celestin tube should rather not be introduced by open surgery. Radiological and endoscopic investigation preoperatively is strictly advised. Furthermore, the indication for a Celestin tube depends on the localisation of the obstruction. In our view, the commercially available tubes (Medoc, Medinex Ltd.) supplied in 3 standard lengths are perfectly satisfying.