Retrospective Analysis of Palliative Oesophageal Stenting at a District General Hospital in the UK; Is it time to fix migration?

Aims We aimed to retrospectively appraise the outcomes of patients who have undergone oesophageal stent insertion for all causes over a 32-month period in a UK district general hospital.

Methods Retrospective data for fluoroscopy guided endoscopic oesophageal stenting over a 32-month period (Jan 2021 to Oct 2023) was collected from MEDILOGIK; an online database and reporting system for endoscopic procedures. Patient demographics and outcome measures relating to procedure indication, complications, 30-day mortality, 8-day readmission, intervention location, type of stents and survival post procedure were analysed. We defined re-intervention as the need for therapeutic endoscopy requiring any of; re-stenting, and/or laser ablation, and/or dilatation (balloon or bougie) after index stent insertion.

Results 49 patients underwent oesophageal stenting with 3 different types of SEMS being used by three operators. For 28 patients (57%), index stent insertion was a definitive procedure. For the remaining 21 patients (43%), re-intervention for second stent placement or exchange, laser, bougie or balloon dilatation was required for recurrence of dysphagia. The mean patient age was 74 years, (range 36 to 93 years). Overall, 30-day mortality was 10% (N=5) and the 8-day readmission rate was 2% (N=1). Perforation occurred in 3 patients, but only one was directly related to stent insertion. Amongst the 21 patients needing re-intervention, stent migration (defined as>2cm of distal or proximal movement from original level of deployment) occurred in 25% (N=12). 9 patients required laser therapy for tumour ingrowth (18%) while 20% (N=10) underwent balloon dilatation. 17/21 needed second stent insertion or stent exchange (35%). The majority of tumours were junctional or lower oesophageal cancers (N=37). 3 patients had early stent migration to the stomach and 3 patients had haemostatic clips applied after stent deployment which were ineffective in preventing migration. The overall mean survival post stent was 4 months. [1] [2] [3] [4] [5]

Conclusions Whilst oesophageal stenting is effective and safe for patients with advanced oesophageal cancer, stent migration occurred in one quarter of all patients. Haemostatic clips did not appear to be effective for stent fixation. We suggest stent fixation with dedicated over the scope clips should be made routine practice for palliative stent insertion. These have been shown to be a cost effective and definitive option to reduce re-intervention in a significantly frail and comorbid population.

Publication History

Article published online:
15 April 2024

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