Introduction SEMS is an accepted endoluminal palliative treatment for symptom control in patients with oesophageal cancer. Current practice of SEMS placement including techniques, pre and post procedure care varies widely across the UK; with many hospitals admitting patients both pre and post procedure.1
Aim To evaluate the safety and effectiveness of day case SEMS placement for oesophagogastric cancer.
Method Retrospective case note review of all patients undergoing SEMS placement from Jan 2012 to Dec 2014 was performed. Day case patients were admitted to the endoscopy unit in the morning, standard consent and sedation procedures was followed. SEMS inserted under radiological and endoscopic or endoscopic guidance alone. Patients were monitored for 1.5–2 hrs post procedure, nurse led discharge with a prescription for oral liquid opiates, antiemetics and Proton pump inhibitors. All had telephonic access to a dedicated cancer specialist nurse during working hours and on call team out of hours. Inpatients needing stenting followed similar protocol for post-procedure care. Relevant outcomes data was collected and statistical analyses were performed on GraphPad Prism Version 6 and Epi Info 7.
Results138 procedures were carried out on 127 patients (41 women, 86 men) with a median age 78.2 (IQR 69–83.25, Range 52–96). 93 patients had adenocarcinoma, 26 squamous cell carcinoma, 6 extrinsic compression and 2 benign diseases. SEMS deployment was successfully achieved in all 138 procedures, 79 as day case (DC) and the rest 59 as inpatients (IP). Median stent length used was comparable in the groups DC 11 cm (IQR 10–12), IP 11 cm (IQR 10–12.5). Good dysphagia alleviation was obtained in both groups (dysphagia scores: IP cohort pre-stent 2.7 ± 0.16, post-stent 0.57 ± 0.66 P < 0.001; DC cohort pre-stent 2.63 ± 0.11, post-stent 0.48 ± 0.17 P < 0.001). Median survival was 136 days (IQR 43–171) in IP group and 125 days (IQR 29.65–183.5) in DC group. DC cohort reported more post procedure pain requiring analgesia and reflux symptoms as compared to IP. Bleeding (minor), stent migration and 30 day mortality was comparable in the two groups. No major procedure related complications reported.
Conclusion SEMS placement as day case is safe and complication rates and mortality is equivalent to inpatients. In our hospital, the basic cost of a general medical hospital bed day is £330, thereby equating to a £26000 in total cost saving per day of admission in bed cost. Day case SEMS produced a reduction in hospital admissions and hospital bed day occupancy with major cost savings.
Disclosure of interest None Declared.
The Royal College of Surgeons of England, National Oesophago-gastric Cancer Audit, 2013