Abstract
Background: Oesophageal cancer often presents in advanced stages not amenable to surgical resection. In such patients, palliation of dysphagia remains the mainstay of management. Objectives: To determine the burden of advanced oesophageal cancer and to document the experience with endoscopic metal stent intubation for its palliation Design: Retrospective evaluation of upper gastrointestinal (GI) endoscopy data and prospective study of stented patients. Setting: St Mary’s Mission Hospital, Nairobi, Kenya. Subjects: Records of and patients who underwent upper gastrointestinal endoscopy and endoscopic stenting were evaluated . Results: Between July 2000 and July 2007, 8580 upper GI endoscopies were carried out, revealing tumour in 796 patients (9.3%). Oesophageal cancer (both squamous cell and adenocarcinoma) accounted for 512 cases (64%), 328 (64%) being males. Only 49 (9.6%) of the oesophageal tumours were deemed amenable to and underwent resection with curative intent. One hundred self expanding metal stents (SEMS) procedures were carried out over a 17-month period (March 2006 – July 2007). Of these procedures, performed under topical anaesthesia and injectable analgesics, only seven involved re-stenting. All patients were able to swallow immediately after. Procedure-related mortality was 2%. Early procedure-related chest pain was a consistent feature (100%). At follow-up, over half of the patients (54%) had an objective weight gain before stabilizing or reducing as other tumour effects set in. The main study challenge was patient compliance with follow-up clinics. Conclusion: Approximately one in ten patients referred for upper GI endoscopy had a tumour in this series. Oesophageal cancer was a common endoscopic finding and only a small percentage (9.6%) was amenable to resection. Endoscopic stenting was found to be an affordable and effective minimally invasive outpatient procedure for palliation of dysphagia in non-resectable disease. Key words: Oesophageal cancer, unsedated endoscopy, stenting (SEMS).
Highlights
Oesophageal carcinoma is the seventh most common malignancy worldwide and patient presentation is often late [1,2]
Approximately one in ten patients referred for upper GI endoscopy had a tumour in this series
Oesophageal cancer was a common endoscopic finding and only a small percentage (9.6%) was amenable to resection
Summary
Oesophageal carcinoma is the seventh most common malignancy worldwide and patient presentation is often late [1,2]. Evidence of distant spread or extensive local direct invasion into surrounding structures such as the tracheobronchial tree, aorta or vertebra by an oesophageal carcinoma precludes curative resection [3,4,5]. Despite protocols that combine use of surgery, radiation therapy and chemotherapy for lesions associated with submucosal spread, lymph-node involvement, and extension to surrounding structures [5], long-term survival is infrequent. The efficacy of CT in preoperative staging of oesophageal carcinoma varies according to the location of the primary lesion, and it has limitations in terms of staging lymph-node involvement [5], an important prognostic feature in resected oesophageal cancer [9]. Oesophageal cancer often presents in advanced stages not amenable to surgical resection. In such patients, palliation of dysphagia remains the mainstay of management
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