PTU-032 Endoscopic stenting – a five year retrospective study

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Abstract

Introduction

Oesophageal, duodenal, gastric (UGI) and colorectal stenting are procedures performed every week in Musgrove Park Hospital Taunton, (a 700 bed District General Hospital in the Southwest of England).

Introduction

Division of labour betweeen Gastroenterology, Radiology and Surgical Teams.

Introduction

Most stenting performed for palliative symptom relief in malignant obstruction and a small proportion of cases are for benign peptic stricturing.

Introduction

We examined our current practice including patient symptoms, morbidity and mortality. Established standards not well defined in this area and so compared our outcomes against our historic practice and against other centres.

Method

Retrospective analysis of procedures between June 2011 and June 2016 and survival up until November 2016.

Method

289 recorded cases over this period (a representative sample of cases cases performed). These detailed both colorectal stenting and UGI stenting.

Method

Data taken from endoscopy records, patient‘s letters, MDT outcomes and the Somerset Cancer Register..

Method

30 day mortality, 8 day readmission rates, survival post stent and designation of the endoscopist or operator in this cohort examined.

Method

In subcohort of 159 cases (cases from November 2013 until June 2016) patient‘s pain score post procedure as well and dysphagia scores pre and post procedure (within the upper gastro-intestinal stenting cohort) examined. Select cohort chosen because previously patients symptoms not consistently recorded. Dysphagia score was derived from the National Oesophago-gastric Cancer Audit. Pain score was classified numerically 0 (no pain) - 3 (breakthrough pain despite opiates.

Results

Key findings (all cases):

Results

Survival range 0–1219 days

Results

Mean age of patient 73

Results

Male 203, Female 86

Results

30 day mortality - 23% (excluding benign cases)

Results

8 day readmission rate: 5.9% (11.9% if including those remaining in hospital for ongoing care)

Results

Procedures performed:-

Results

Oesophageal (including gastro-oesophageal): 176

Results

Stomach: 3

Results

Duodenal (including gastric pylorus): 40

Results

Colorectal: 70

Results

Patient Symptoms (Upper GI):-

Results

- Any dysphagia at one month 42% (96% pre stent), mean dysphagia score 0.85 (2.86 pre stent)

Results

- Any dysphagia at 3 months 39%, mean dysphagia score 0.39

Results

- Mean pain score pre stent 0.58, 0.46 one month post stent.

Results

Patient symptoms (Colorectal):-

Results

- Mean pain score 1.03 pre stent to 0.11 one month post stent.

Results

Specific Mortality Data:-

Results

Oesophageal: 30 day mortality 20.1% Mean survival 135 days

Results

Duodenal: 30 day mortality 17.1% Mean survival 147 days

Results

Colorectal 30 day mortality 20.0% Mean survival 239 days

Results

Complication and failure rates:-

Results

Failure of procedure: 14.4%, Minor Complication:1.9%

Results

Serious Complications: 3.1% (Of which 2.5% could have contributed to death)

Conclusion

UGI stenting leads to improvement in dysphagia but no change in pain score. Lower GI stenting leads to gross improvement in pain score. Our survival data is comparable to similar published data although our average age of patient is higher than comparable studies.

Disclosure of Interest

None Declared

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