title: Long Term Outcome in Patients with Esophageal Stenting for Cancer Esophagus - Our Experience at a Rural Hospital of Punjab, India.
abstract: BACKGROUND
  Cancer of the esophagus is among the leading cause of cancer deaths in Punjab, India. Patients generally present with dysphagia as their first symptom and more often they have advanced disease at the time of presentation to a tertiary care centre. Palliative procedures have important roles in this setting. Stenting is the best option to palliate the symptoms of dysphagia, from which patient is suffering the most.
  
  
  OBJECTIVE
  To know the success rate, early and long term complications and mortality in esophageal stenting, when it was done in malignant esophageal stricture patients.
  
  
  METHODS
  One hundred patients, who had undergone esophageal stenting from January 2012 to January 2015, were included in the study. We retrospectively analysed the data for patient characteristics, causes of non-operability, early and long term complications, re-interventions, efficacy and mortality.
  
  
  RESULTS
  Out of 100 patients, indications for stenting were locally advanced disease not amenable to surgery (52%), metastatic disease (35%), CVA (1%), cardiac and respiratory problem (8%), un-willing for surgery in 5% of patients. Majority of patients (94%) had squamous cell carcinoma, while only 6% had adenocarcinoma. 84% of patients presented with dysphagia with or without chest pain and recurrent cough while 16% had recurrent vomiting. 58% had dysphagia to liquids and solids and 17% had complete dysphagia. After stenting 93% had significant improvement in dysphagia score from median of 3 to 1. Post procedure stay was 3.61±1.0 days. One patient had procedure related major complication in the form of post procedural bleed (after 16 days of stenting) leading to death of that patient. Minor complications were present in 52 patients treated conservatively not affecting the efficacy of procedure. These include pain after stenting (38%), stent obstruction (23%) and stent migration (6%). All the minor complications were treated conservatively except in six patients in whom re-stenting was done.
  
  
  CONCLUSIONS
  Esophageal stenting is relatively safe procedure with short stay of the patient in the hospital. Although, it helps in alleviating patients' morbidity very effectively and reliably, there are many technical glitches, which needs to be kept into account and patient should be properly counseled before the procedure to prevent and manage post procedure complications and medico legal aspects.
authors.affiliation: Assistant Professor, Department of Surgery, Gian Sagar Medical College , Ram Nagar, Rajpura, Patiala, Punjab, India .
authors.forename: Parvinder
authors.initials: P
authors.lastname: Singh
authors.affiliation: Junior Resident, Department of Surgery, Gian Sagar Medical College , Ram Nagar, Rajpura, Patiala, Punjab, India .
authors.forename: Abhitesh
authors.initials: A
authors.lastname: Singh
authors.affiliation: Junior Resident, Department of Surgery, Gian Sagar Medical College , Ram Nagar, Rajpura, Patiala, Punjab, India .
authors.forename: Anantbir
authors.initials: A
authors.lastname: Singh
authors.affiliation: Assistant Professor, Department of Biostatistics, ESIC Medical College and PGIMSR , Banglore, Karnatka, India .
authors.forename: Ghansham
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Professor, Department of Surgery, Gian Sagar Medical College , Ram Nagar, Rajpura, Patiala, Punjab, India .
authors.forename: Parmod Kumar
authors.initials: PK
authors.lastname: Bhatia
authors.affiliation: Professor, Department of Surgery, Gian Sagar Medical College , Ram Nagar, Rajpura, Patiala, Punjab, India .
authors.forename: Amarjeet Singh
authors.initials: AS
authors.lastname: Grover
keywords: Cancer esophagus; Dysphagia; Post-procedure