31 patients with inoperable malignancies of the esophagus were treated for severe dysphagia or fistula by endoscopic placement of an endoprosthesis. The mortality rate was 4%. 56% of the patients with dysphagia and 55% with fistulation experienced relief of symptoms. Complications occurred in about one third of all patients. Median patient survival after diagnosis was 9 months. Median survival after placement of the endoprosthesis was 25 days (25 and 75% quartiles 10 and 50 days, minimum and maximum 1 and 371 days respectively). Prior to placement of an endoprosthesis 66% of the patients had already been treated by chemotherapy, radiotherapy, repeated bougienage or laser photocoagulation. Almost all patients died as a result of their primary illness with the tube still in place. In patients with neoplastic fistulation palliative intubation is the therapy of choice. In addition to intubation, alternative methods are available today for treatment of severe dysphagia. However, further investigation is needed to determine the patients who will benefit most from the placement of a prosthesis.