Introduction Management of dysphagia due to oesophageal cancer can be challenging and self-expanding metal stents (SEMS) have an important role in this. SEMS have been placed under direct vision in our institution since 2004 and a previous audit showed a significant rise in numbers particularly repeat stenting. A new referral protocol was implemented from 2011 to better aid assessment and appropriate insertion of SEMS and so the aim of this study was to assess changes in trends of SEMS insertion following this.
Method Retrospective analysis of all oesophageal SEMS inserted in our institution from 2004 to 2014 was performed. Patient demographics, tumour pathology and location, repeat stenting and 30 day mortality were recorded. Emerging trends were analysed by examining changes on a yearly basis and proportional analysis before and after the change in referral protocol.
Results 393 patients with a mean age 72.9 years (242 males) were included with 510 SEMS being inserted overall (117 repeat stents) and Figure 1shows this graphically. Median age was 77 in 2004 which dropped steadily over the decade to 71 in 2010 and then remained between 73–75. SEMS insertion increased significantly from 6 in 2004 to 74 in 2011 and then dropped to 52 over the next 3 years. Repeat stenting rose until 2012 (1 in 2004 to 18 in 2011) and then fell following the change in protocol. The majority of tumours were adenocarcinomas (>60%) and were in the distal oesophagus or gastro-oesophageal junction. 30 day mortality peaked in 2010 and then steadily declined following the change in protocol but has increased again in the last year.
Conclusion There has been a significant increase in the number of SEMS inserted in our institution over the last decade. The previous audit revealed that patients were likely being stented too soon and the change in protocol has reduced overall numbers but more importantly repeated stenting. The recent rise in mortality may represent SEMS being inserted closer to the end of a patients life and therefore a true palliative intervention.
Disclosure of interest None Declared.
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