7048 Relief of dysphagia with self expanding metal stents is far from perfect

• Published in: Gastrointestinal endoscopy 2000-04, Vol.51 (4), p.AB254-AB254
• Main Authors: Lovat, Laurence B., Mathou, Nicoletta, Thorpe, Sally M., Gertner, David, Sargeant, Ian R., Winslet, Marc C., Bown, Stephen G.
• Format: Article
• Language: English
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)14719-4

Background: Most people with oesophageal cancer present with advanced disease and palliation of dysphagia is the main aim of therapy. Self expanding metal stents (SEMS) have become the standard treatment but patient outcome is not well documented, particularly in routine practice. This is a retrospective analysis of patients treated in 2 district general hospitals and 2 teaching hospitals. Patients and Methods: Hospital notes were reviewed on 75 consecutive patients in whom a SEMS was inserted between January 1996 and May 1997. Site of tumour was: 38 adenocarcinoma of distal oesophagus or cardia; 21 squamous cell carcinoma of the mid or upper body; 5 bronchogenic carcinoma with oesophageal involvement; in 11 the site was not noted. 5 had broncho-oesophageal fistulae and 1 an iatrogenic perforation following tumour dilatation. Results: 88 stents (44 covered) were placed in 75 patients (mean age 70, range 37-92). Stenting was primary therapy for most patients. 4/5 (80%) fistulae were adequately closed. Mean survival for all patients after stent insertion was 67 days (range 5-259). Most were only able to tolerate fluids before stent insertion. In the 42 patients for whom adequate records were kept, only slight improvement of dysphagia was achieved after stent insertion, and most tolerated only pureed food. In 9 of these patients, no improvement was seen in severity of dysphagia, and in 1 other, stenting made dysphagia worse. Severe pain occurred after stent insertion in at least 24 patients (32%) and was intractable in 7 (9%). 4 patients (5%) died within 10 days of stent insertion (2 aspiration pneumonia, 1 stridor, 1 haemorrhage). 16 patients (21%) developed late stent related morbidity. Tumour overgrowth or ingrowth was treated with an overlapping stent in 8 patients (1 required a total of 4 stents); tumour ingrowth was treated with laser in 1 patient; 1 patient died from massive haematemesis at 5 months. This patient had previously undergone radiotherapy. 2 covered metal stents migrated into the stomach whereas this was not seen with uncovered stents.A total of 45 extra endoscopies were performed after stent insertion. Conclusions:In routine practice, SEMS improve dysphagia less well than in trials from specialist centres. Pain is common and can be intractable. Early stent related morbidity is very common and late morbidity occurs in 21%. Furthermore, early mortality after stent insertion is significant and relief of dysphagia appears to be no better than