Non-Fluoroscopic Purely Endoscopic Stent placement for Upper GI Pathology: A safe, cost effective practice.

Matthew J Lyon, Dr1, Paul Mousa, Dr2, Abheiney Jain, Dr3, Bimal Sood, Dr4, Kamal Heer, MD5, Harish Kumar, MD1. 1University of Queensland, 2Prince Charles Hospital, 3Royal Free Hospital London, 4Toowoomba Hospital, 5Monash Univeristy

Introduction: Self expanding metal stents are widely used in palliation & treatment of GIT pathology. This study reports a single surgeon's results utilizing purely endoscopic technique without fluoroscopy.

Material and Methods: 201/202 [failed to intubate one] patients were stented using only endoscopic technique. Full or partially covered distal release stents with or without anti-reflux mechanism were used. The stent was placed over a guide wire and opened under endoscopic visual control. Final position was assessed endoscopically. All patients were allowed fluids orally within two hours of procedure once they were fully awake. All procedures were done under appropriate sedation.

Results:

Demographics
Pathology [Total Number] [201] Average Age [Min-Max]

 Male:Female

Esophageal/Upper Gastric[161]

75 years [46-92 years] 8 M:79F
Pyloric/Duodena [11] 78.9 [69-90 years] 8M:3F
Post Resection Leak [6] 66.7 [50-76 year 4M:2F
TOF/Others[6] 58.5 [17-84] 6M: 0F
Post bariatric Surgery Leak[17] 49.3 [26-73 years] 7M:10F

 

Duration of stents

Number of Patients Pathology Duration of stent
161 Esophageal/Upper Gastric carcinoma Natural Life
17 Post Bariatric procedure Leak 3-13 Weeks
11 Duodenal/Pyloric Obstruction 10 lifelong/1 removed in lymphoma patient
12 Post Esophageal Surgery leak/ TOF 4-12 weeks

Of the 161 cancer patients 6 were already inpatient. Of the rest, 142/155, were treated as a day-case. 12 stayed overnight for social reasons or discomfort.

80 of the cancer patients required dilatation before stenting. Balloon dilatation was used to facilitate intubation. One patient with upper esophageal cancer was unable to be intubated.

7 patients had another procedure  to add another or reposition the existent stent.One patient had chest pain post procedure and an elevated white cell count but no radiological evidence of leak. Patient improved with 48 hours of antibiotics and was discharged on fourth day.

There was no 30-day mortality. There was no clinical or radiological evidence perforation despite one suspected perforation.

Conclusion: Purely Endoscopic Upper GI stenting is versatile, safe and saves cost of fluoroscopy and radiographer and excludes risks of radiation.

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