275. SAFETY AND TREATMENT RESULTS OF SELF-EXPANDABLE METAL STENT (SEMS) PLACEMENT FOR ESOPHAGEAL DISEASE

Abstract

Abstract Background Self-expandable metal stent (SEMS) placement for esophageal strictures and fistulas caused by malignant tumors has been reported from various institutions as a relatively minimally invasive and safe palliative treatment. SEMS placement is often selected for cancer-bearing patients whose general condition has already deteriorated, but there are many unknowns regarding the risks and benefits of placement. Methods We retrospectively examined swallowing scores, oral intake status, complications and prognosis for 41 cancer-bearing patients who underwent SEMS placement in our hospital from 2011 to 2023. Results There were 29 men and 12 women, with a median age of 77 years. The types of cancer were esophageal cancer / gastric cancer / lung cancer / others in 22/12/3/4 cases, respectively. The reason for stent placement was stricture / fistula in 39/2 cases. Stent placement was successful in 40 cases (97.6%), and complications were observed in 7 cases (17.1%), including bleeding, displacement, and aspiration pneumonia in 2, 3, and 2 cases, respectively. Three patients underwent second stent placement for restenosis, and the median time to restenosis was 57 days. After stent placement, dysphagia score improved in 30 cases (78.9%). After stent placement 35 patients (87.5%) chose palliative treatment and the median survival time (MST) was 1.7 months (0.2-10.8). Comparing patients with PS≦2 and PS≧3 using performance status (PS) at the time of stent placement, patients with PS≦2 significantly ate more after stent placement (median amount of oral intake; 80 % vs. 40%, p=0.037), and the survival period was longer (MST; 3.1 months vs. 1.3 months, p=0.0018). Univariate analysis on the risk of complications by stent placement showed that chemotherapy history, radiotherapy history, and pretreatment dysphagia score were not risk factors, but poor PS (≥3) was the only significant risk factor (Odds ratio: 12.5, 95% CI:1.3-117, p=0.027). Conclusion Esophageal stents are less invasive treatment than any other palliative methods, like esophageal bypass or radiation therapy for patients who strongly desire oral intake. However in patients with poor general condition the risk of complications is high and the survival period is not long, so it should be performed after fully explaining the risks and benefits.