Radiographer involvement with stent insertion to palliate symptomatic dysphagia resulting from neoplastic obstruction

Abstract

Self-expanding metal stent (SEMS) insertion is recognized as an effective palliative treatment for patients with symptomatic dysphagia resulting from inoperable neoplastic occlusion. This paper reviews radiographer involvement in the fluoroscopic deployment of SEMS. One hundred and fifty-eight SEMS were passed in 136 consecutive patients. Radiographers were responsible for the barium swallow and subsequent passage of an oro-gastric wire across the strictured lumen. One hundred and twenty-seven guide wire insertions under fluoroscopic control transgressed the tumour lumen at first attempt. Nine (6.6%) guide wire insertions were unsuccessful at first attempt however two patients (2.7%) had successful second attempts at fluoroscopically guided wire insertion. Five patients went on to have a joint endoscopic/fluoroscopic SEMS procedure, three were successful, two failed. Due to poor health it was decided not to proceed with further intervention with two other patients. With an overall success rate of 96%, a joint radiographer/clinician approach to guide wire insertion and subsequent SEMS deployment using fluoroscopy alone is a safe, time- and cost-effective procedure.