Introduction Dysphagia occurs in 70% oesophageal cancers,1self-expanding metal stents (EMS) are an established palliative treatment for dysphagia, fistula and perforation.2
Method We review our Centre’s experience of EMS placement since 1997. Over 17 years all EMS were placed by a single operator (GT) using a standard dual Endoscopy and Radiology assisted technique. A Database was maintained and analysed for this review.
Results 397 EMS were placed in 373 patients (25–35/year). Average age 74 years, 59% were men. 97% placed for malignant disease; 83% for dysphagia palliation, 14% for fistulae and 3% for benign perforation. 3/4 of tumours were lower oesophageal. Adenocarcinoma was the commonest tumour type (46%), the majority of these were male (75%). Squamous made up 24%, with 63% being female; the rest were poorly differentiated (10%), and miscellaneous (20%) including breast, lung, mesothelioma and melanoma.
Most tumours were 2–10cm long, 68% had moderately tight stricturing but only 18% of all tumours required dilatation (average 11mm). Tumour clearance was successful in 99% where an EMS was deployed. 1/3 procedures were considered technically challenging, reasons included; difficult tumour anatomy e.g. angulation (15%) and inability to cross the tumour after dilatation resulting in ‘blind’ distal placement (5%). EMS placement was unsuccessful in 1% and failed to expand adequately or slipped from the ideal position in 5%. Bleeding occurred in 4%, all minor, and resuscitation due to respiratory arrest occurred in 1 case. 30 day mortality was 10%; 1 patient died within 24 h of EMS placement.
Stent choice changed over time; Ultraflex (Boston Scientific) was used between 1998–2006 and partially covered Ni-Ti stents (various manufacturers) thereafter.
Conclusion Our patient demographics reflect national trends in age, sex and tumour type3. 99% achieved successful EMS placement, 18% required dilatation for placement. Our complication rate is similar to published work but the rate of severe bleeding and 30 day mortality were lower than published figures of 1% and 24% respectively.4
In our 17 year experience, EMS are a useful palliative treatment for oesophageal cancer with high success rates of placement and relatively low incidence of complications.
Disclosure of interest None Declared.
Brierley JD, Oza AM. Radiation and chemotherapy in the management of malignant esophageal strictures. Gastint Endo Clin N Am. 1998;8(2):451–463
Hindy P, Hong J, Lam-Tsai Y, Gress F. A comprehensive review of esophageal stents. Gastroenterol Hepatol. 2012;8(8):526–534
Office for National Statistics. Cancer survival rates, cancer survival in England, patients diagnosed 2005-2009, followed up to 2010. Nov 2011 [Online] www.ons.gov.uk
Martinez J, Puc M, Quiros R. Esophageal stenting in the setting of malignancy. ISRN Gastroenterol. 2011; 2011:719575. [Published online]
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