The Annals of Thoracic Surgery, Vol 40, 337-342, Copyright © 1985 by The Society of Thoracic Surgeons
Pulsion intubation versus traction intubation for obstructing carcinomas of the esophagus
HW Unruh and KM Pagliero
Eighty-eight patients were intubated to relieve the dysphagia of malignant
esophageal obstruction. Because of advanced metastatic disease or poor
general condition, 49 patients could not be operated on and were intubated
endoscopically. Under radiographic control, the Nottingham Introducer was
used to position Atkinson or modified Celestin tubes. In 39 other patients,
palliative resection could not be done or liver metastasis was found at
preliminary exploration with a view to esophagectomy. In these patients,
Celestin tubes were inserted by the traction technique. The pulsion
intubation group was older than the traction intubation group but
comparable in other respects. Hospital stay was significantly shorter for
the pulsion intubation group (8.4 versus 18.6 days). Hospital mortality
rates were comparable (14.3% in the pulsion intubation group versus 23.1%
in the traction intubation group), and survival did not differ (93 days in
the pulsion intubation group versus 137 days in the traction intubation
group). Overall complication rates were similar, but there were two
significant differences: (1) wound infection or dehiscence was a major
problem in the traction intubation group, occurring in 23% of the patients;
and (2) tube obstruction or displacement occurred more frequently in the
pulsion intubation group (18.3% versus 5.1%) but did not constitute a
serious problem. Perforation occurred in 4 patients (8.2%) in the pulsion
intubation group but was fatal in only 1. Pulsion intubation offers
distinct advantages over traction intubation in that hospital stay is
decreased and morbidity reduced.
