OGC P13 Outcomes of Endoscopically Guided Stent Insertion in the Upper GI Tract in a Single Centre

Abstract

Abstract Background Self-expanding metal stents (SEMS) are useful for palliation in patients suffering from dysphagia for malignant disease in the upper gi tract. Patients can resume oral intake, so improving nutrition and quality of life. Establishing the efficacy and complication rate of stents are important for informing patients to aid decision making when giving consent for SEMS insertion in the scenario of a short life expectancy. Methods A single centre's records were interrogated over a 10 year period for stents inserted in the upper gi tract. Data for stents inserted between 2011 and 2021 was retrospectively collected from electronic records for baseline demographics and outcomes in terms of complications and then subject to analysis. There was missing data in a number of domains and analysis was done on data available, no imputation of data was performed. Results Five hundred and sixty eight patient episodes were identified with a mean age of 73. There were 386 males and 170 females. Sites of obstruction were Lower Third of the oesophagus 279, mid-oesophagus 71, GOJ 37, upper oesophagus 15, unknown 9, duodenum 3, Cardia 1, and stomach other 1. Surgeons inserted 394 (70%) of stents and gastroenterologists 167 (30%). There were 212 covered stents, 248 not specified, 29 partially covered and 3 uncovered. When outcomes were measured, 276 had no complication (69%), 105 had a (any) complication (25%) and 32 had missing data (8%). There were 14 cases of bleeding (3%). There were 25 cases of stent migration (6%) and 54 cases of tumour overgrowth (13%). There were 43 cases of stent obstruction (10.4%), 3 cases of some stricturing (0.73%) and 366 with no blockage or stricture reported (88.6%), 1 case could not be determined. There were 2 cases of perforation (0.48%). Median survival was 105 days with IQR 44–210. Conclusions Our results for adverse events are not too dissimilar to the literature however there may be an under-reporting of some adverse events due to the terminal nature of the disease process the majority of the patients in this group have. Stents can relieve dysphagia and help regain quality of life. However there is a significant complication rate that should be taken into account. This information from a large dataset is useful to inform potential stent patients to aid decision-making. Data for significant known symptoms such as reflux and retrosternal chest pain were not reliably available and a prospectively kept database measuring PROMs information including relief of dysphagia will better inform patients.