EFFECTIVENESS OF SELF-EXPANDING METALLIC STENTS IN THE PALLIATION OF ABSOLUTE DYSPHAGIA IN CARCINOMA OESOPHAGUS- A 1-YEAR FOLLOW-UP STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 11
Abstract
BACKGROUND Palliation of dysphagia is the primary goal in the care of inoperable oesophageal carcinoma and the usual option is palliative chemoradiotherapy. But radiation induced complications made chemoradiation a less favourable option for managing dysphagia. Rapid improvement in dysphagia with minimal complications and technical simplicity made SEMS the primary option in the palliation of dysphagia. The aim of this study was to assess the outcomes of inoperable oesophageal malignancy presented with absolute dysphagia, who were treated with SEMS placement. The objective of our study was to assess the effectiveness of SEMS in palliation of Grade 4 dysphagia due to oesophageal carcinoma. Other aims were the technical success rate, complications and survival. MATERIALS AND METHODS This is a single group cohort study done in the Department of General Surgery, Government Medical College, Thrissur, during a period of 1 year from 1st June 2013 to 31st May 2014, with a mean follow-up of 1 year. Patients presented to Surgery Department with absolute dysphagia due to carcinoma oesophagus, offered palliative SEMS. Clinical success rate, technical success rate, complications and survival was analysed. RESULTS 34 patients were selected for stenting based on inclusion and exclusion criteria. We were able to place SEMS successfully in 29 patients. The technical success rate was 85.29%. A clinical success rate was 96.55%. Post stent score was Gd 3 in 19 (65.5%), Gd 2 in 7 (24.1%), Gd 1 in 2 (6.9%) and Gd 4 in 1 (3.4%). Wilcoxon Signed Rank Test ‘z’ value was 4.813 (p value < 0.001). Median survival was 20 weeks (95%, CI 12.08 - 27.91). There was one procedure related mortality due to oesophageal perforation. Incidence of recurrent dysphagia in our study was 17.24%. It was due to stent migration in 2 (06.89%) and tumour overgrowth in 3 (10.34%). CONCLUSION SEMS is an effective method in palliation of dysphagia due to oesophageal carcinoma. Significance of this study is that it specifically examines the effectiveness of SEMS in a group of patients with absolute dysphagia as a primary palliative modality. This aspect is important considering the limited radiation facilities and high cost of chemotherapy in emerging nations like ours.
Authors and Affiliations
Pauly Thazhungal Joseph, Santhosh Thekkoot Vijayan, Sudhiraj T. S
Keywords
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- EP ID EP411660
- DOI 10.14260/jemds/2018/318
- Views 97
- Downloads 0
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