Iftikhar H Khan, Roger Vaughan.
Three years experience with Pulsion Atkinson Tube: The realistic option for palliation of dysphagia due to inoperable oesophageal cancer in Pakistan.
J Coll Physicians Surg Pak Jan ;9(3):123-6.

107 Atkinson intubations were performed in 101 patients including 25 females and 76 males with a mean age of 72 years (range:44-95 years). Average hospital stay for tube insertion was 4.29 days (range 1-27 days). 41% patients never required a second admission. 41 % patients required one more admission, while 19% patients needed a further 2-6 admissions. Total hospital stay after insertion of the tube, including subsequent admissions, averaged 12 days (range 1-82 days). Procedure related mortality was 10.3% and morbidity was 13.08 % There was little effect of age, sex, size of Atkinson tube used and preoperative treatment with radiotherapy on morbidity or mortality. The longest survival was 517 days and the mean survival was 95.6 days. Forty three patients died at home while 34 patients died in an acute hospital ward. A review of literature is given on the subject. We conclude that Atkinson tubes provide adequate and reliable palliation of dysphagia in carcinoma of oesophagus at a reasonable cost even in the elderly. The procedure however is associated with considerable mortality and morbidity. Expandable wire mesh memory stents are likely to replace the Pulsion tubes once their prices come down. At the present moment, per oral Pulsion Atkinson intubation (or intubation with any similar pulsion tube available locally) is the realistic method of choice for relief of dysphagia due to in-operable carcinoma of the oesophagus in the vast majority of patient population in countries like Pakistan.

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