Celestin Tube Research Articles

Palliation for carcinoma of the esophagus.

From 1950 to 1973, 169 patients received irradiation for esophageal squamous cell carcinoma. The average survival time was 10 months, with 7% of the patients living 2 years or more. The median survival time was 7 months; palliation averaged 6 months. Most completing therapy (89%) achieved some palliation: 66% had significant relief of dysphagia for 2 months or longer. The anatomical location of the malignant obstruction did not influence therapeutic response; there was similar response in cases of upper, middle, and lower esophageal lesions. Thirty patients with progressive obstruction underwent endoesophageal intubation with Celestin tube placement; this procedure provided symptomatic relief with minimal morbidity.

Fixation of Celestin tube to the anterior abdominal wall: A new technique

Palliative intubation in the management of an unresectable carcinoma of the esophagus can be accomplished by "push through" or "pull through" techniques. The most frequently encountered complication is tube dislodgment-proximal or distal migration. Dislodgment occurs more freqeuntly with the "push through" tubes such as the Souttar tube than with the "pull through" tubes such as the Celestin tube. The incidence of migration reported for the "pull through" tubes varies from 3 to 14 per cent. In order to prevent migration, we sutured the tube to the anterior abdominal wall in 6 patients. The sixth patient developed a gastrocutaneous fistula and fasciitis at the point of anterior abdominal wall fixation. In the next 4 cases, we used a two-suture technique, in which no single suture passed from the gastric lumen to the anterior abdominal wall fascia. The Celestin tube was fixed to the gastric wall over a Dacron felt pledget and this pledget was then anchored to the rectus fascia. This technique has prevented both migration of the tube and complications related to gastric perforation.

Treatment of malignant esophageal obstruction by endoesophageal intubation

Experience with Celestin tube placement in thirty-four patients is described. Two patients died within thirty days of operation, and two other patients were not significantly relieved by the procedure. Although some problems inevitably occur with endoesophageal intubation, it is concluded that this method to relieve symptoms of esophageal obstruction is preferable to more extensive operative procedures, radiotherapy alone, or gastrostomy.

A Simple Technique for Intubation of the Esophagus for Fistulae and Obstructions

We have used a new technique for palliation of tracheoesophageal fistulae and esophageal obstruction in five patients. In all cases, swallowing was satisfactory the day following intubation, with the elimination of aspiration. Moreover, we have no instance of obstruction or dislodgement of the prosthesis. In one case, a benign esophagobronchial fistula from a caseating node was healed using a Celestin tube. This technique has eliminated major surgery in debilitated patients, allowing them to eat the day following peroral intubation.

Palliation of advanced esophageal carcinoma by permanent intubation

Sixteen patients with severe dysphagia due to nonresectable carcinomas of the esophagus had insertion of Celestin tubes for palliation of dysphagia and/or control of tracheoesophageal fistula. Thirteen patients survived 1 to 11 months (average 4.1 months) following the operation and had good relief of dysphagia. Tracheoesophageal fistula was well controlled in 3 of 4 patients. Esophageal perforation occurred in 2 patients with one death, and blockage of the tube by food boli occurred in 3 patients. Peroral intubation with the Celestin tube is at present our treatment of choice for nonresectable carcinoma of the esophagus with severe dysphagia and/or tracheoesophageal fistula.

Management of Oesophageal Carcinoma:A Report of 267 Cases

A series of 267 patients with oesophageal carcinoma is presented. There were 151 women and 116 men; the mean age was 65 years. During the whole period 1960–1971 surgical excision was the treatment of choice. The overall operability was 45.2% and the re-sectability of the whole material 30.3%, but 66.9% of the cases were considered operable. Eighty-one patients were treated by surgical excision and anastomosis. The method of choice was one-stage oesophagectomy and oesophagogastrostomy. Altogether 87 patients received irradiation therapy alone. This group consisted of patients who were found inoperable at exploration or estimated to be unsuitable for radical surgery. In the group of 99 patients without active therapy, feeding gastrostomy or a Celestin tube was used in 43 cases.Early mortality rate after oesophageal resection was 18.5%; 13% during the last 6-year period. During this period one-third of the patients were more than 70 years of age. Anastomotic leakage was verified in five cases (6.2%), three of these died. Pulmonary embolism was the most usual cause of death. After radiotherapy, pulmonary fibrosis, strictures and fistulas occurred in 32%. The 5-year survival rate after excisional surgery was 22% and the 3-year survival 38%. After radiotherapy, the 3-year survival rate was 4% and 2-year survival 10%. After complete cobalt therapy, the 2-year survival rate was 15%. The mean survival time after roentgen therapy was 9.1 months, after cobalt therapy 11.1 and after photon therapy 10.6 months. The mean survival time of the untreated cases was 4.0 months. The overall 5-year survival for the total series was 7.8%.

Celestin-Tube Palliation for Malignant Esophageal Obstruction

The inlying Celestin tube has continued to provide reasonably effective palliation for patients with hopeless esophageal cancer. Its greatest advantage is the immediate relief of dysphagia with the bonus of improved morale for patient, physician, and family.

Radiologic aspects of celestin tube intubation for incurable obstructive esophageal carcinoma.

The radiologic aspects of the Celestin tube in place in patients with incurable obstructive esophageal carcinoma are described. The Celestin tube currently in use has a flexible latex shaft with an inkwell-shaped funnel and pressure-free edges. There is a radiopaque line along the shaft, enabling visualization of the tube without the aid of contrast medium. Complications of intubation include slipping, partial occlusion, and blockage. Tumor related complications include fistula formation and perforation of the esophagus by the edge of the tube due to tumor extension. In a series of 21 patients, palliative treatment by Celestin tube intubation was beneficial.

Treatment of Esophageal Disruption by Intubation: A New Method of Management

Esophageal intubation was employed to seal esophageal leaks in patients with malignant tracheoesophageal fistula; anastomotic leak following esophagogastrectomy; and instrumental or spontaneous perforation in the normal, the inflamed, and the carcinomatous esophagus. In all these instances the Celestin tube controlled the esophageal spillage and facilitated spontaneous healing of the defect. Esophageal intubation is not recommended as an alternative to suture repair for ordinary perforations of the esophagus. The procedure, however, seems to be an effective treatment for disruption of the esophagus in life-threatening situations in which operative intervention poses prohibitive risks and in situations in which the direct operative approach is not applicable.

Use of Celestin tube for palliation of malignant oesophageal obstruction.

Palliation of dysphagia due to malignant obstruction of the oesophagus by passage of the Celestin tube is described in 36 cases. Although there was a high initial mortality, this was most marked when the tube was used to palliate dysphagia due to enlarged posterior mediastinal glands. Satisfactory palliation was obtained in all but one patient, and four patients survived more than six months in relatively good health. Tracheo-oesophageal fistula responded particularly well to the use of the indwelling tube. Gastro-intestinal bleeding and would complications accounted for the main morbidity following the procedure.

Palliation of esophageal carcinoma by prosthetic intubation

Summary and conclusions A simple technique for palliative intubation of malignant esophageal obstruction is described. It has been successfully applied in cases of obstruction at all levels of the thoracic esophagus, the gastric cardia, and after esophagogastrostomy. A prosthesis of recent design appears to have significant advantages over the Mousseau-Barbin and Celestin tubes.