title: Self-expanding metal stents (SEMS) for patients with advanced esophageal cancer in Malawi: an effective palliative treatment.
abstract: OBJECTIVE
  Esophageal cancer is common in Malawi and most patients are inoperable at time of diagnosis. The aim of this study was to prospectively evaluate palliative treatment with self-expanding metal stents (SEMS) in Malawi, a low-income country with limited medical resources.
  
  
  METHODS
  Data of patients with advanced inoperable esophageal cancer were prospectively collected. Tumor and patient specifics, risk factors, dysphagia scores, complications, and survival were assessed. Follow-up data for 1 year or until death were collected from 118/143 patients (83%) during clinic visits, home visits, or via cell phone.
  
  
  RESULTS
  One hundred forty-three patients were treated with 154 SEMS. Median survival was 210 days (95% CI: 150-262 days). Fourteen of 118 patients with complete follow-up (11.9%) survived more than 1 year with longest documented survival of 406 days. The median dysphagia score improved from 3 at the time of presentation to 0 at the time of death. Early complications occurred in 4.2% (6/143), late complications in 11.9% of patients (14/118). The procedure related mortality was 2.1% (3/143).
  
  
  CONCLUSIONS
  SEMS is an appropriate palliative treatment in a resource-limited environment. For the vast majority of patients a single intervention provides lasting improvement of dysphagia.
authors.affiliation: Department of Surgery, Queen Elizabeth Central Hospital, University of Malawi, College of Medicine, Blantyre, Malawi. alex_thumbs@hotmail.com
authors.forename: Alexander
authors.initials: A
authors.lastname: Thumbs
authors.forename: Eric
authors.initials: E
authors.lastname: Borgstein
authors.forename: Leo
authors.initials: L
authors.lastname: Vigna
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.forename: Kai
authors.initials: K
authors.lastname: Hellberg
authors.forename: Jane
authors.initials: J
authors.lastname: Bates
authors.forename: Torsten J
authors.initials: TJ
authors.lastname: Wilhelm
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008295:Malawi; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate
chemical_list: D008670:Metals