SUMMARY Of one hundred and twenty-one patients with neoplastic obstruction of the oesophagus or cardia 118 underwent palliative intubation at fibreoptic endoscopy on a total of 135 occasions. Sixty had adenocarcinoma, 49 had squamous carcinoma, and in nine the oesophagus was involved by a growth arising elsewhere. Satisfactory swallowing was restored in 112 patients. Thirteen patients died in hospital shortly after the procedure. Five fatal and 10 non-fatal perforations were sustained in 135 intubation procedures. Complications of tube function included food blockage on 26 occasions, tumour overgrowth on seven occasions, displacement on 16 occasions, disappearance of the tube in two patients, and late oesophageal perforation on nine occasions. Fifty-six patients survived for three months, 33 for six months, and 10 for a year after intubation. Comparison with series in the literature of patients who underwent surgical palliative intubation suggests that endoscopic palliation has lower mortality and morbidity, and an increased survival time, and is now the method of choice for palliation of oesophagogastric neoplasms.Carcinomas of the oesophagus and gastric cardia cause progressive dysphagia and, in the absence of treatment, starvation is a common cause of death. Surgically incurable disease is present in over 60%of patients at the time of presentation' and in the majority of these patients palliative relief of dysphagia is of pressing importance. Any method of palliation should therefore have a low mortality and morbidity, preferably associated with a short hospital stay, and be effective in the relief of dysphagia. For many years prosthetic oesophageal tubes inserted either by operation or endoscopic means have been used to relieve dysphagia,2-5 but operative methods require a laparotomy and rigid endoscopic methods may be associated with a high incidence of oesophageal perforations, especially with lesions in the lower oesophagus. The advent of fibreoptic endoscopy has facilitated the placement of prosthetic tubes which may be slid into position over the endoscope itself6 or over a guide wire after mounting on an introducer.7 The quality and duration of life after intubation depend, among * Present address: Gastroenterology Unit,

SummaryPalliative intubation for inoperable malignant strictures at the cardia was done on 16 occasions in 13 patients using fibreoptic endoscopy. Preliminary dilatation was performed, and the Celestin tube was mounted on an introducer and passed over a guide wire inserted with a fibreoptic endoscope. Only one death resulted from the procedure and all the 12 patients who left hospital were swallowing satisfactorily on discharge. The method provided a simple and relatively safe means of relieving dysphagia and improving nutrition.

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A method of relieving dysphagia in inoperable oesophagogastric neoplasms by per oral intubation using the Nottingham tube introducer was attempted in 63 patients with 3 failures. Twelve patients died within 10days of intubation, including 4 from a perforation of the growth sustained during the procedure, and 51 patients left hospital swallowing satisfactorily. The average period of survival was 3 months and 10patients survived for a year or more, including 2 in whom the tube was removed after regression of a squamous carcinoma following radiotherapy. Endoscopic per oral intubation is a simple and relatively safe procedure which when used in patients with oesophagogastric neoplasms gives adequate symptomatic relief and allows home management in the terminal stages of the illness.

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