Introduction Palliative stenting is now established as a major treatment for dysphagia resulting from inoperable oesophageal cancer. There are many possible complications after oesophageal stent insertion; most of these present with increasing dysphagia; however pain, bleeding, and reflux are also common. Although data on rates of various complications are available, there are no agreed standards to audit performance against, nor any requirement to do so. As this is a palliative procedure, success in symptom control is paramount; if this is not being achieved, then the appropriateness of the procedure must be questioned. As with any invasive procedure, complication rates are affected by multiple variables: technique, type of stent, length and site of stricture, operator experience, and patient co-morbidities. As a result of these variables, stated complication rates also vary: Only one study reported a rate of dysphagia (29%); migration occurred in 5–15% of cases, tumour overgrowth 5–20%, and food bolus obstruction in 5–15%. Quoted median survival ranged from 61–104 days, with a 30-day mortality of 20–28%.
Method A retrospective study of all patients undergoing oesophageal stent insertion at a single endoscopy unit during 2012–13 was undertaken, looking for evidence of complications, repeat interventions, and for survival statistics after stent insertion. Patients who had undergone stent insertion for reasons other than oesophageal malignancy were excluded.
Results During the two-year period, 74 stents were inserted in 62 patients for palliation of malignant dysphagia. Of these stent insertions 24 (32.4%) were documented to have recurrent dysphagia, of which the causes were: tumour over- or ingrowth in 7 (9.5%); stent migration in 5 (6.8%); obstruction due to gastric folds, hiatus hernia, or anti-reflux valve in 3.(4.1%); and food bolus obstruction in 2 cases (2.7%). In total there were documented complications post stent in 32 (43.2%) of all stent insertions, with pain in 8 (10.8%), bleeding in 6 (8.1%), and nausea or refluxing 3 cases (4.1%) accounting for the complications which did not cause dysphagia. Median survival of the 74 patients after stent insertion was 95 days and 30-day mortality was 9.7% (6 patients). It is important to note that with retrospective data analysis, some data are not available, due to variations in recording at the time and a reliance on the patient to report symptoms to a clinician.
Conclusion Palliative stenting at this centre continues to be an effective treatment for patients with malignant dysphagia. Outcomes compare favourably with published data in terms of recurrent dysphagia, other complications, and mortality. Steps to improve post-procedure monitoring in the form of a “stent registry” with prospective collection of data by telephone or face-to-face follow up could be useful in future service development.
Disclosure of interest None Declared.
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