Introduction Oesophageal stenting is an important treatment option in the palliation of malignant dysphagia. There are few guidelines on choice of stents among the wide range that is available, or on how best to monitor outcomes in clinical practice. We have introduced a pragmatic symptom assessment questionnaire that ensures that patients are followed up in a structured way, and present our initial experience here.
Method Stenting for oesophageal cancer is done by one of two senior endoscopists, using Boston Wallflex or Ultraflex stents. Cases are selected after MDT review and stent choice is guided by age and tumour characteristics
The questionnaire was introduced in June 2015 and includes 3 scores: dysphagia, pain and performance status. This is completed prior to stenting then at days 7 and 28, with follow up information obtained in person or by telephone contact from nurse specialists.
For this analysis we analysed all scores and compared outcomes between different stent types, lengths and diameters. Secondary outcomes included rates and predictors of 30 day readmissions and mortality. Statistical comparisons were performed using general linear modelling, Kaplan-Meier and regression analyses.
Results 55 patients underwent oesophageal stent insertion from June 2015 to Dec 2016 (Wallflex 42; Ultraflex 13;). Median age was 76 years; 42% were day cases and 58% were inpatients. Stenting led to reduced dysphagia scores at week 0, 1, 4 (p<0.001). Pain increased at day 7 (not significant) but reverted to baseline at day 28. There were no differences in performance status before and after stenting. Primary outcomes did not differ with stent type, diameter or length. Among day cases, 5/22 (22.7%) were admitted for an average of 3.6 days (range 1–8). Overall 30 day readmission and mortality rates were 16% and 20% respectively. 10 patients underwent 13 repeat OGDs of which 3 required a second stent. Median post-stent survival was 222 days (95% CI, 102–341.) Higher dysphagia scores, at week 0 correlated with increased mortality (p=0.005) [Figure 1]; but performance status did not correlate.
Conclusion Our questionnaire ensures both clinical follow up and a structured evaluation of outcomes. We have incorporated this into routine practice We have not identified difference in outcomes between different stent types used but will continue prospective evaluation of our practice .
- oesophageal cancer
- oesophageal stent
- symptom score
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