The incidence and management of complications following stenting of oesophageal malignancies

Authors

Keywords:

oesophageal cancer, self-expanding metal stents, endoscopic stenting, oesophageal stent

Abstract

Background: Oesophageal stenting effectively palliates malignant dysphagia with reported high technical and clinical success rates approaching 90% and a low, though often problematic, complication frequency. This study aimed to benchmark success rates, the incidence and management of complications at a tertiary interventional endoscopy centre.

Methods: This single centre three-year (March 2018–March 2021) study reviewed demographics, tumour histology/position, and early and late complications of palliative oesophageal stenting. A multivariate analysis of tumour position association with complications was performed.

Results: A total of 297 patients (73.4% squamous cell carcinoma) underwent 354 stent insertion attempts. Immediate technical insertion success rate was 97.5% with dysphagia improvement achieved in all successful insertions (100% clinical success rate). Three hundred and forty-six (98.6%) were fully covered stents, with 17 (4.8%) placed for tracheaoesophageal fistulae. Twenty-one (6.0%) immediate insertion-related complications occurred, including two oesophageal perforations, but no insertion-related mortalities. Late complications occurred in 73 (20.8%) with tumour overgrowth (10.1%) and stent migration (6.1%) being the most frequent. Of all 354 stents, 75.2% had no documented complications for the lifetime of that stent, while 68 complications required re-intervention, equating to a re-intervention rate of 19.4% per stent insertion. Stent migration was significantly higher in distal tumours (11.8% vs 1.8%, p < 0.001), while discomfort necessitating same-day stent removal was higher in proximal tumours starting at < 20 cm from the incisors (16.7% vs 0.5%, p < 0.001).

Conclusion: Oesophageal stenting for malignant dysphagia is peri-procedurally safe and effective. Outcomes reported from this South African cohort compare favourably to high-volume international units.

Author Biographies

G Teyangesikayi, University of Cape Town

Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

MF Scriba, University of Cape Town

Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

S Viranna, University of Cape Town

Department of Radiation Oncology, Groote Schuur Hospital, University of Cape Town, South Africa

EG Jonas, University of Cape Town

Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town

GE Chinnery, University of Cape Town

Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

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Published

2023-12-14

Issue

Section

Surgical Oncology