Resumo

TEYANGESIKAYI, G et al. The incidence and management of complications following stenting of oesophageal malignancies. S. Afr. j. surg. [online]. 2023, vol.61, n.4, pp.27-32. ISSN 2078-5151.  http://dx.doi.org/10.36303/sajs.4036.

BACKGROUND: Oesophageal stenting effectively palliates malignant dysphagia with reported high technical and clinical success rates approaching 90% and a low, though often problematic, complication frequency. This study aimed to benchmark success rates, the incidence and management of complications at a tertiary interventional endoscopy centre. METHODS: This single centre three-year (March 2018-March 2021) study reviewed demographics, tumour histology/ position, and early and late complications of palliative oesophageal stenting. A multivariate analysis of tumour position association with complications was performed. RESULTS: A total of 297 patients (73.4% squamous cell carcinoma) underwent 354 stent insertion attempts. Immediate technical insertion success rate was 97.5% with dysphagia improvement achieved in all successful insertions (100% clinical success rate). Three hundred and forty-six (98.6%) were fully covered stents, with 17 (4.8%) placed for trachea-oesophageal fistulae. Twenty-one (6.0%) immediate insertion-related complications occurred, including two oesophageal perforations, but no insertion-related mortalities. Late complications occurred in 73 (20.8%) with tumour overgrowth (10.1%) and stent migration (6.1%) being the most frequent. Of all 354 stents, 75.2% had no documented complications for the lifetime of that stent, while 68 complications required re-intervention, equating to a re-intervention rate of 19.4% per stent insertion. Stent migration was significantly higher in distal tumours (11.8% vs 1.8%, p < 0.001), while discomfort necessitating same-day stent removal was higher in proximal tumours starting at < 20 cm from the incisors (16.7% vs 0.5%, p < 0.001) CONCLUSION: Oesophageal stenting for malignant dysphagia is peri-procedurally safe and effective. Outcomes reported from this South African cohort compare favourably to high-volume international units.

Palavras-chave : oesophageal cancer; self-expanding metal stents; endoscopic stenting; oesophageal stent.

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