P-0011 Single Institutional Experience of Biodegradable Stents in Patients Receiving Non-Surgical Treatment for Oesophageal Cancer

Abstract

ABSTRACT Introduction Biodegradable (BD) stents are licensed for the treatment of benign strictures resistant to conventional dilatation. They provide immediate relief of symptoms and degrade over 3-4 months. Dysphagia associated with oesophageal cancer is palliated with self-expanding metal stents. Improving malignant dysphagia using BD stents may provide additional benefits, particularly in combination with radical radiotherapy (RT). We aimed to determine whether BD stents are beneficial in improving dysphagia and nutritional status in these patients. Methods A retrospective review of oesophageal cancer patients treated with BD stent insertion at a major cancer centre was undertaken. The % change in body weight and O’Rourke dysphagia score (1= normal diet, 2= selective solids, 3= pureed diet, 4= liquid diet, 5= total dysphagia) was recorded prior to and at a median 29 days following insertion. Stents used were self-expanding polydioxanone stents (Ella-BD; Ella-CS, Hradec Kralove, Czech Republic). Institutional review board approval was given for use in malignant strictures. Results 26 patients (12 male, 14 female) were identified from a central database between 2008 and 2011. Median age was 71.4 years (range 40–87). The tumour site involved the lower 1/3 in 15 patients, mid-oesophagus in 7 patients and oesophagogastric junction in 4 patients. BD stents were placed prior to radical (chemo-) RT in 12 patients, for post-RT strictures (negative biopsy or no confirmed recurrence) in 10 patients, during peri-operative chemotherapy in 2 patients and during palliative chemotherapy in 2 patients. The O’Rourke scores improved in 14 patients, were stable in 8 patients, deteriorated in 1 patient, unknown in 3 patients. Median change in % body weight was -8.4 (range -14% to +20.0%) Weight remained stable in 15 patients, deteriorated in 5, improved in 3 and was unknown in 3. Stent complications occurred in 6 patients (23%), of which 4 had post-RT strictures; these included GI haemorrhage in 2 patients, (both post-RT strictures and managed conservatively). 1 patient with post-RT stricture managed by multiple previous dilatations and stents had trachea-oesophageal fistulation. 1 had severe pain, 1 had failure of stent expansion, 1 had food bolus obstruction. Repeat procedures (re-insertion of BD stent or metal stent, dilatation or unblockage) were required in 9 patients (34%) for recurrent symptoms. See table 1. Conclusion Biodegradable stents provide some improvement in dysphagia within their useful period of 3-4 months. Although this is a small series, they potentially offer a new strategy for patients receiving radical RT or managing RT strictures by medium-term dilatation, without the need for removal. Benign post-RT strictures show a higher complication rate. Further prospective studies are needed to investigate the role of BD stents in improving nutrition and dysphagia in this patient group, particularly in patients treated with RT. Table 1 . Effect of BD stent in 2 patient subgroups with oesophagael cancer.