Introduction SEMS is an accepted palliation for dysphagia in patients with oesophageal cancer. Endoscopic technique (ET) for SEMS insertion has previously been shown to be safe, effective, less time consuming with improved positioning especially of the proximal end of the stent. The obvious limitation of ET is in non-traversable tumours (with standard endoscope), requiring ultraslim scopes which are not widely available. We employ a hybrid approach, using fluoroscopy for dilatation followed by direct endoscopic insertion of SEMS. Aims:To evaluate the outcomes following HT versus standard FT for oesophageal SEMS placement.
Methods Retrospective case note review of all patients undergoing SEMS placement from Nov 2011 to Oct 2013 was performed. Data was collected on patient demographics, endoscopic and other outcome variables including re-intervention rates and survival. Statistical analyses were performed on GraphPad Prism Version 6 and Epi Info 7.
Results 110 procedures were carried out on 96 patients (28 women, 68 men) with a median age 77.5 years (IQR 69–83.25, Range 52–99). 75 patients had adenocarcinoma, 19 squamous cell carcinoma and 2 benign diseases. SEMS deployment was successful in all 110 procedures. Of the 46 traversable tumours, 22 underwent ET and 24 FT for SEMS placement. 64 patients had non traversable tumours (with standard endoscope). HT was used in 21 and FT in 43 patients. Length of the stent deployed was not statistically different in both groups (HT 11.4 ± 0.5 cm, FT 11.0 ± 0.5 cm, P = 0.98). Good dysphagia alleviation was seen in both groups (dysphagia scores, HT cohort pre-stent 2.7 ± 0.16, post-stent 0.53 ± 0.87 P < 0.001; FT cohort pre-stent 2.53 ± 0.09, post-stent 0.44 ± 0.11 P < 0.001). Cumulative complications (reflux, pain, bleeding, food bolus obstruction) were similar for both techniques (HT 0.28 ± 0.1, FT 0.34 ± 0.1, P = 0.62). There was a tendency towards higher re-intervention for tumour overgrowth in the FT cohort (FT 7/43 patients, 129.4 ± 35.5 days; HT 2/21 patients, 215 ± 60 day, P = 0.33). Neither the stent length (P = 0.89) nor the technique used, had an influence on the need for re-stenting for tumour overgrowth (P = 0.68). Median survival was 141 days (IQR 46–180) in the HT group and 121 days (IQR 27.75–188.5) in the FT group. There were no instances of stent migration in the non-traversable group.
Conclusion Outcomes following SEMS insertion in both techniques were similar. Hybrid approach is an acceptable alternative to fluoroscopy only, in patients with non-traversable tumours, with the added advantage of more accurate positioning of the proximal end of the stent under direct endoscopic visualisation. Limitations of the study are its retrospective nature, lack of data on diameter of stents.
Disclosure of Interest None Declared.