title: Insertion of expandable metallic stents in esophageal cancer without fluoroscopy is safe and effective: a 5-year experience.
abstract: BACKGROUND
  Self-expanding metallic stent (SEMS) placement is an important method of dysphagia palliation for patients with inoperable esophageal cancer. In most institutions, it is performed with fluoroscopic guidance; however, in 2001, we described a novel, direct-vision approach to SEMS placement, which does not require fluoroscopy. Here we report an audit of our experience over the last 5 years when using this methodology.
  
  
  OBJECTIVE
  To describe our 5-year experience of 98 patients in whom esophageal stents were inserted when using the direct-vision technique and compare outcomes with published series of radiography-guided stents.
  
  
  METHODS
  Retrospective review of single-center experience.
  
  
  METHODS
  English National Health Service Cancer Centre Hospital.
  
  
  METHODS
  All patients who underwent esophageal stent insertion for a primary esophageal malignancy.
  
  
  METHODS
  SEMS insertion by direct endoscopic vision.
  
  
  RESULTS
  Ninety-eight patients underwent SEMS insertion for malignant dysphagia during the study period, 92% of which were inserted without fluoroscopy. The technique had a low complication rate, which was consistent with published fluoroscopic data, and the median survival beyond stent insertion was 100 days (interquartile range, 62, 256; range, 4-921 days). In 59 patients, no further endoscopic palliative procedure was required.
  
  
  CONCLUSIONS
  Retrospective data collection.
  
  
  CONCLUSIONS
  This series confirms direct-vision SEMS placement as a safe and efficacious method of malignant dysphagia palliation, providing definitive treatment in almost two thirds of cases.
authors.affiliation: Derby Digestive Diseases Unit, Derby Hospitals NHS Foundation Trust, Derby City General Hospital, Derby, Derbyshire, United Kingdom.
authors.forename: Emilie A
authors.initials: EA
authors.lastname: Wilkes
authors.forename: Lucina M
authors.initials: LM
authors.lastname: Jackson
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Cole
authors.forename: Jan G
authors.initials: JG
authors.lastname: Freeman
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Goddard
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000628:therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals