Introduction Oesophageal cancer is often diagnosed late in its pathological process and as a consequence management is often focussed on palliation of symptoms. The insertion of oesophageal stents tend to occur in small numbers and as such any individual endoscopist will perform only a few in a given time period. In this study we aim to establish whether by limiting this procedure to a few operators we can improve outcomes by increasing operator experience.
Methods This is a retrospective review of palliative stenting in patients with advanced oesophageal and oesophagogastric cancers across East and North Hertfordshire NHS Trust in the 15 month period from 1st April 2011 – 31st July 2012. We audited endoscopy reports and our prospectively maintained Upper Gastrointestinal Cancer database for any reported post procedural complications and calculated 7, 14 and 30 day mortality rate for these cohort patients. We also re-audited complications following stent insertion from March 2010–2011 where stents were performed by the first available gastroenterologists. Results were analysed according to BSG Quality indicators and compared with National Oesophagogastric cancer Audit 2010.
Results 20 patients had palliative stents with in this time period. The median age was 74 and male to female ratio is 3:2. 70% of cases were adenocarcinoma and 20% were Squamous cell carcinoma. The combination of pharyngeal anaesthesia and sedation were used only in 10% (n = 2) compared to 21% last year. Procedures carried under fluoroscopy guidance were 100% compared to 36% nationally. Boston Scientific Ultraflex covered metal stents were used in 95% of patients. All the stents were deployed successfully. No reported complications of stent migration (compared to 12% migration rates last year), perforation and haemorrhage post procedure. This was achieved with two gastroenterologists with special interest performing the procedure compared to five consultants last year. Our 7, 14 and 30 day mortality are as shown in the graph below.
Conclusion We use laser therapy first line where appropriate. This usually achieves a better dysphagia grade than stenting initially. This means that our patients have been palliated for several months before stents are inserted. Despite this patient selection seems to be appropriate as most survived more than 30 days. No complications were noted with insertion and post stent, this was a major improvement from last year’s audit. From this study we have demonstrated that by treating oesophageal stent insertion as a specialist procedure, with dedicated operators we are able to minimise complication rates.
Disclosure of Interest None Declared.
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