In case of pending starvation from obstruction at the cardiac orifice, whether on the oesophageal or stomach side of the sphincter, the question of gastrostomy will arise ; but it must first be made clear that the obstruction is organic, and not from mere spasm that might be overcome by milder means. For this purpose an oesophageal bougie may be employed, and if this is arrested at the entrance to the stomach or just before, and if the obstruction fails to yield to gentle pressure sustained for a short time, the stricture is probably organic, and if slight bleeding results from the gentle use of a bougie the stricture is probably due to cancer.

If the stricture occurs before middle age it may be desirable to give an anaesthetic before finally deciding in order to overcome spasm should that be the cause arresting the passage of a bougie.

Such a stricture may be examined directly by means of Killian's tube for cesophagoscopy, and the use of a forehead light.