PWE-191 17 years of oesophageal stent insertion: experience from a tertiary centre

Abstract

<h3>Introduction</h3> Dysphagia occurs in 70% oesophageal cancers,¹self-expanding metal stents (EMS) are an established palliative treatment for dysphagia, fistula and perforation.² <h3>Method</h3> We review our Centre’s experience of EMS placement since 1997. Over 17 years all EMS were placed by a single operator (GT) using a standard dual Endoscopy and Radiology assisted technique. A Database was maintained and analysed for this review. <h3>Results</h3> 397 EMS were placed in 373 patients (25–35/year). Average age 74 years, 59% were men. 97% placed for malignant disease; 83% for dysphagia palliation, 14% for fistulae and 3% for benign perforation. 3/4 of tumours were lower oesophageal. Adenocarcinoma was the commonest tumour type (46%), the majority of these were male (75%). Squamous made up 24%, with 63% being female; the rest were poorly differentiated (10%), and miscellaneous (20%) including breast, lung, mesothelioma and melanoma. Most tumours were 2–10cm long, 68% had moderately tight stricturing but only 18% of all tumours required dilatation (average 11mm). Tumour clearance was successful in 99% where an EMS was deployed. 1/3 procedures were considered technically challenging, reasons included; difficult tumour anatomy e.g. angulation (15%) and inability to cross the tumour after dilatation resulting in ‘blind’ distal placement (5%). EMS placement was unsuccessful in 1% and failed to expand adequately or slipped from the ideal position in 5%. Bleeding occurred in 4%, all minor, and resuscitation due to respiratory arrest occurred in 1 case. 30 day mortality was 10%; 1 patient died within 24 h of EMS placement. Stent choice changed over time; Ultraflex (Boston Scientific) was used between 1998–2006 and partially covered Ni-Ti stents (various manufacturers) thereafter. <h3>Conclusion</h3> Our patient demographics reflect national trends in age, sex and tumour type³. 99% achieved successful EMS placement, 18% required dilatation for placement. Our complication rate is similar to published work but the rate of severe bleeding and 30 day mortality were lower than published figures of 1% and 24% respectively.⁴ In our 17 year experience, EMS are a useful palliative treatment for oesophageal cancer with high success rates of placement and relatively low incidence of complications. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Brierley JD, Oza AM. Radiation and chemotherapy in the management of malignant esophageal strictures. Gastint Endo Clin N Am. 1998;8(2):451–463 Hindy P, Hong J, Lam-Tsai Y, Gress F. A comprehensive review of esophageal stents. Gastroenterol Hepatol. 2012;8(8):526–534 Office for National Statistics. Cancer survival rates, cancer survival in England, patients diagnosed 2005-2009, followed up to 2010. Nov 2011 [Online] www.ons.gov.uk Martinez J, Puc M, Quiros R. Esophageal stenting in the setting of malignancy. ISRN Gastroenterol<i>. </i>2011; 2011:719575. [Published online]