ABSTRACT
Background: To determine the usefulness of metallic stent in advanced
oesophageal malignancies. Methods: In a retrospective study conducted at the
Endoscopy Unit of King Abdulaziz University Hospital, patients underwent stent
placement, with or without palliative radiotherapy for inoperable esophageal
cancer, during the period spanning January 2010 through December 2014. Ethical
approval for this study was granted by the King Abdulaziz University Research
Ethics Committee. Data were collected from the electronic database of the
hospital. All patients underwent OGD before stenting to know site of tumor,
length of tumor and degree of stricture. Barium meal and CT scan was also done
in some cases to know exact characteristics of tumor. Stent was selected more
than 2 cm longer than the length of tumor. Self expanding metallic stents were
used in all cases. Confirmation of proper placement of stent was done using
fluoroscopy. Complications post stenting were analysed. Results: A total of 15
cases were studied. Males were 53.3% while females were 46.7%. Youngest patient
was 39 yr old and eldest was 79 years with mean 64.93 years. Mean height was
159.73 cm and mean weight 54.98 kilogram. Co-morbidities like DM was 20%, DM
with HTN was 6.7%, bronchial asthma 13.3% and DM with HTN with IHD and Renal
implant in 6.7%. Diagnosis at admission was esophageal squamous cell carcinoma
in 33.3%, esophageal adeno-carcinoma in 53.3%, gastric cancer in 6.7%,
tracho-esophageal fistula in 6.7%. Stage 3 was 13.3%, and stage 4 was 86.7%. Surgical
resection and palliation was done in14.2%, and only palliation was done in
92.9% of cases. SEMS were used in all patients and majority had Niti-S stent
placed in 73.3% and Wallflex in 13.3% and Ultraflex in 6.7% and Boston in 6.7%
cases. Dysphagia was Indication of stenting in 100% of cases and stricture in
57.1% and stricture and recurrent aspiration in 42.9%. Post stenting
complications were early in 20% and late in 40%. Tumor ingrowth was in 20%, GERD
in 20%, Mild chest pain and discomfort in 10%, stent migration in 10%, fistula
formation in 10%, chest pain and GERD in 10%, and aspiration and pneumonia in
20%. Conclusions: Self expanding metallic stents are invaluable in advanced
oesophageal cancer for palliation and alleviation of symptoms and better
quality of life. Patients prior to chemoradiotherapy may get benefit of
stenting making oesophageal passage patent which may otherwise get occluded by
edema caused by radiotherapy.