Experiences with the Montgomery Salivary Bypass Tube (MSBT)

Patients with hypopharyngeal and cervical esophageal strictures and fistulas caused by advanced malignancy, ingestion of caustic material, or following surgery or radiation therapy often suffer from marked dysphagia. In such cases the implantation of a Montgomery Salivary Bypass Tube (MSBT) can be an effective therapeutic option to bridge the fistulous tract or bypass a stenosis. Being able to eat and drink without the need for intravenous supplementation or nasogastric or gastrostomy tube feeding in general greatly improves the patient's quality of life. Since 1981 we have successfully inserted the MSBT in 44 cases suffering from dysphagia of different etiology. Our experiences with the indications for implantation, insertion techniques, and postoperative results are presented. Three selected cases of progressive dysphagia in which the MSBT is demonstrated to be the treatment of choice are described in more detail. In one case, a tracheoesophageal fistula and in another a stricture of the upper esophageal sphincter (UES) were bypassed so that oral intake of soft food became possible again. The third patient suffered from a disturbance of the esophageal motility after resection of a Hippel-Lindau tumor in the spinal cord and syringe drainage; even swallowing saliva was impeded. After insertion of a MSBT, uncomplicated soft food intake became possible again.