Oesophageal stenting in a district general hospital.
BACKGROUND
Oesophageal carcinoma is the ninth most common malignancy in the UK with five year survival rate of only 8%. Most patients with dysphagia present at an advanced stage. Endoscopic stent insertion is a valid method of palliation. We present the outcomes of patients stented at a district general hospital.


METHODS
This is a retrospective study of patients presenting to a district general hospital with inoperable oesophageal obstruction resulting in stent insertion from December 2000 to September 2006. Case notes were reviewed for demographics, diagnosis, treatment, complication and outcome.


RESULTS
Fifty-seven patients were stented endoscopically by a single surgeon during the study period for incurable oesophageal obstruction. Forty were male and 17 female (mean age 71.9 range 39-92). Most common causes were advanced adenocarcinoma (34; 60%) and squamous cell carcinoma (16; 28%). Other rarer causes were benign stricture of the oesophagus, lung carcinoma, non-Hodgkin's lymphoma and salivary gland tumour. Of the 50 patients with oesophageal carcinoma, strictures were in the lower third (in 68%), middle third (in 30%) and proximal third (in 2%). Twenty-four (42%) patients developed a complication, including overgrowth (14; 25%), migration (8; 14%), tracheo-oesophageal fistula (2; 4%) and perforation (1; 2%). There was an overall improvement in dysphagia in 41 (72%).


CONCLUSIONS
Endoscopic stenting for advanced oesophageal obstruction is a well-tolerated procedure, which is acceptable to patients. Despite a significant complication rate, it allows the relief of dysphagia in most patients and therefore should be considered for all patients in this category.
Morgan
J L
JL
Department of General Surgery, Rotherham General Hospital. jenna.morgan@doctors.org.uk
Khan
H N
HN
Lambertz
M M
MM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D006113:United Kingdom