A review of the incidence and management of complications following malignant oesophageal stenting

Teyangesikayi, Gilbert

A review of the incidence and management of complications following malignant oesophageal stenting

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Division of General Surgery

Faculty

Faculty of Health Sciences

Abstract

Background Stenting provides effective palliation of malignant dysphagia for irresectable tumours due to either local invasion, metastatic disease, or poor performance status. Immediate technical success rates are very high, with clinical improvement approaching 90% in most reported series. Complications specific to oesophageal stenting include perforation, pain, aspiration, volume reflux, bleeding, migration, tumour overgrowth and ingrowth. Methods This retrospective audit of palliative oesophageal stenting over a three-year period (March 2018 - March 2021), with review of technical and clinical outcomes, aimed to determine local incidence and management of complications. Results The majority (73.4%) of palliative stents were placed for squamous cell carcinoma (SCC) with a total of 354 stent insertion attempts undertaken in 297 patients (49 requiring multiple stents). Three unsuccessful insertions and six incorrectly placed stents, all immediately addressed, equated to an immediate technicalsuccess rate of 97.5%. Most (346; 98.6%) were fully covered stents; only two partially covered and three uncovered stents were inserted. Seventeen stents (4.8%) were placed for a confirmed trachea-oesophageal fistula. Twenty-one (6.0%) immediate insertion-related complications occurred, including two oesophageal perforations. Five patients required removal of proximal stents on the same day due to significant globus sensation or chest pain. There was no mortality due to immediate stent insertion related complications. Dysphagia improvement was registered in all (100% clinical success rate) successful stent insertions. Late complications occurred in 73 (20.8%). The most frequent indication requiring reintervention was tumour overgrowth (30; 10.1%) occurring at a median 63.5 days(IQR 41.0 - 103.3 days). Stent migration occurred in 18 patients (6.1%) at a median 28.0 days(IQR 10.0 - 52.8 days). Of the total 354 placed stents, 264 (75.2%) had no documented complications for the lifetime of that stent. When comparing the rate of stent migration and tumour overgrowth by tumour position, distal tumours (>30cm from the incisors) were 8.93 times (p<0.0001) more likely to migrate than proximal tumours (>30cm from the incisors) were 8.93 times (p<0.0001) more likely to migrate than proximal tumours (<30cm). Tumour overgrowth was more likely in proximal tumours, but this did not reach statistical significance. Conclusion: Oesophageal stenting is an effective and safe palliation of malignant dysphagia. Outcomes reported by this cohort from a low/middle income setting compare favorably to high volume international units.

Keywords

surgery

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