Safety of endoscopic self-expanding metallic stent placement in esophageal cancer without fluoroscopy

Abstract

INTRODUCTIONThe incidence of esophageal cancer in India is 4.1% (men -5.7%, women -2.7%).1 It is the sixth common cancer in men and eighth common cancer in women in India. 2 Majority of patients with esophageal cancer are diagnosed at a late stage and only palliation is possible.3 . Patients with esophageal cancer have a five year survival rate of 5-10%. 4 Dysphagia is the main symptom of esophageal cancer, causing weight loss and poor quality of life. Palliative treatment of dysphagia with selfexpandable metal stent (SEMS) insertion is an effective and safe procedure.5,6 SEMS insertion is associated with complications like perforation, bleeding, stent migration, tumor ingrowth and stent occlusion. In majority of previous studies, endoscopic SEMS insertion was done under fluoroscopic guidance. 8,9 However few studies have demonstrated that SEMS can be safely inserted under endoscopic guidance alone without fluoroscopy. [10][11][12][13][14][15] This method of SEMS insertion is important in centers where fluoroscopy is not available. ABSTRACTBackground: Esophageal self-expanding metal stent (SEMS) placement is traditionally done under fluoroscopic guidance. But few authors have shown that esophageal SEMS can be placed without fluoroscopy. The study aimed to assess the safety and success of SEMS placement in patients with carcinoma esophagus under endoscopic guidance without fluoroscopy. Methods: All patients who underwent esophageal stenting for palliation of malignant dysphagia over a 4 year period were reviewed retrospectively. Consecutive patients were identified from the endoscopy report books and inpatient admission files of medical gastroenterology department, Victoria hospital. In one hundred and ten patients with inoperable carcinoma esophagus, SEMS was placed. The procedure consisted of proximal release SEMS insertion under endoscopic guidance without the use of fluoroscopy. They were followed at one week and one month after deployment. All the complications related to the procedure were recorded. Results: 110 patients underwent endoscopic esophageal SEMS insertion for palliation of malignant dysphagia. Stent was successfully placed in all the patients. The mean age of patients was 57.38±21.21 years (range: 31 to 84 years). Dilatation of stricture before SEMS placement was needed in 33 patients (30%). No patient had esophageal perforation or stent migration. Conclusions: Esophageal stent insertion in carcinoma esophagus under endoscopic guidance without fluoroscopy is successful, safe and effective for palliation of dysphagia.

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

“…Meta-regression analysis, however, is a weak statistic in terms of assessing the predictive effects of a variable to the reported outcome. In 14 of the included studies [24,25,[38][39][40][41][42][43][44][45][46][47][48][49], the esophageal stent was deployed under direct endoscopic view where as a through-thescope (TTS) technique was used in only one study [9]. In two studies [50,51], the esophageal stent was placed over a guidewire and confirmation of accurate positioning was done by post deployment endoscopy.…”