Treatment

Categories: MALIGNANT DISEASE OF THE ESOPHAGUS
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The present 100 per cent mortality in cancer of the

esophagus will be lowered and a certain percentage of surgical cures

will be obtained when patients with esophageal symptoms are given the

benefit of early esophagoscopic study. The relief or circumvention of

the dysphagia requires early measures to prevent food and water

starvation. Bouginage of a malignant esophagus to increase

temporarily the size of the stenosed l men is of questionable

advisability, and is attended with the great risk of perforating the

weakened esophageal wall.



Esophageal intubation may serve for a time to delay gastrostomy but

it cannot supplant it, nor obviate the necessity for its ultimate

performance. The Charters-Symonds or Guisez esophageal intubation tube

is readily inserted after drawing the larynx forward with the

laryngoscope. The tube must be changed every week or two for cleaning,

and duplicate tubes must be ready for immediate reinsertion.

Eventually, a smaller, and then a still smaller tube are needed, until

finally none can be introduced; though in some cases the tube can be

kept in the soft mass of fungations until the patient has died of

hemorrhage, exhaustion, complications or intercurrent disease.



Gastrostomy is always indicated as the disease progresses, and it

should be done before nutrition is greatly impaired. Surgeons often

hesitate thus to operate on an inoperable case; but it must be

remembered that no one should be allowed to die of hunger and thirst.

The operation should be done before inanition has made serious

inroads. As in the case of tracheotomy, we always preach doing it

early, and always do it late. If postponed too long, water starvation

may proceed so far that the patient will not recover, because the

water-starved tissues will not take up water put in the stomach.