PWE-111 Reducing 30-day mortality of endoscopic self-expanding metallic stent insertion

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Abstract

Introduction

Self-expanding metallic stents (SEMS) have a well-recognised palliative role in the management of patients with oesophageal cancer. Such stents are inserted endoscopically, under direct vision or under fluoroscopic radiological guidance. There is little evidence to compare these approaches. The objective of this study was to assess the outcomes, using various performance indicators, in patients who underwent endoscopically inserted SEMS for palliation in oesophageal cancer at the Royal Infirmary of Edinburgh (RIE).

Method

A retrospective observational study was conducted at the RIE from January 2010 to August 2011, and compared with outcomes between May 2014 to April 2016. A total of 72 SEMS were inserted in 57 patients (2010–2011) and 73 SEMS in 64 patients (2014–2016). The outcome measures included: adequate SEMS position, short term complications, 1 month dysphagia, additional intervention rates and 30 day mortality post insertion.

Results

Between 2010–2011, 72 stents were inserted in 57 patients (median age 73) and 73 stents between 2014–2016 in 64 patients (median age 74). Most SEMS were inserted as primary or adjunctive therapy alongside chemo- or radiotherapy. Stent positioning was adequate in the majority (99% 2010–11; 98% 2014–16). Where data was available, short term complication rates remained similar across both groups (12% in 2010–11; 11% in 2014–16). Repeat endoscopy with no additional therapy rates reduced by 4% (24% 2010–11; 20% 2014–16). However, those requiring intervention including argon plasma coagulation, clips and laser therapy increased by 18%. There was a 6% reduction in re-stent rates. Overall, 30 day mortality reduced from 21% (2010–2011) to 8% (2014–2016).

Conclusion

The majority of SEMS had satisfactory endoscopic positioning with low post-procedure complication rates. When assessing key performance indicators relating to endoscopically sited SEMS across the two time points, we observed positive and improved outcomes - notably a 13% reduction in 30 day mortality with low post-procedure complication rates; lower compared with published data from other UK centres (18%1). This may be explained by SEMS insertion at earlier stages of disease, frequent and timely intervention and increased operator experience over time, among others. Further studies would be required to corroborate our findings.

Disclosure of Interest

None Declared

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