Article Sidebar
Article Details
Issue
Section
Articles
Authors submitting articles to The Annals of African Surgery do so on the understanding that if accepted, they will retain the copyright and allow the journal to publish and archive the article under the CC BY (Creative Commons Attribution License) 4.0 International. See details on the Creative commons website. All authors will be required to sign an Author Agreement form detailing the agreement with the journal prior to the article being published. Download the form here
This work is licensed under the Creative Commons Attribution 4.0 International License.
Main Article Content
Oesophageal cancer and experience with endoscopic stent intubation at St. Mary’s Hospital, Nairobi
Abstract
Background: Oesophageal cancer often presents in advanced stages not amenable to surgical resection. In such patients, palliation of dysphagia remains the mainstay of management. Objectives: To determine the burden of advanced oesophageal cancer and to document the experience with endoscopic metal stent intubation for its palliation Design: Retrospective evaluation of upper gastrointestinal (GI) endoscopy data and prospective study of stented patients. Setting: St Mary’s Mission Hospital, Nairobi, Kenya. Subjects: Records of and patients who underwent upper gastrointestinal endoscopy and endoscopic stenting were evaluated . Results: Between July 2000 and July 2007, 8580 upper GI endoscopies were carried out, revealing tumour in 796 patients (9.3%). Oesophageal cancer (both squamous cell and adenocarcinoma) accounted for 512 cases (64%), 328 (64%) being males. Only 49 (9.6%) of the oesophageal tumours were deemed amenable to and underwent resection with curative intent. One hundred self expanding metal stents (SEMS) procedures were carried out over a 17-month period (March 2006 – July 2007). Of these procedures, performed under topical anaesthesia and injectable analgesics, only seven involved re-stenting. All patients were able to swallow immediately after. Procedure-related mortality was 2%. Early procedure-related chest pain was a consistent feature (100%). At follow-up, over half of the patients (54%) had an objective weight gain before stabilizing or reducing as other tumour effects set in. The main study challenge was patient compliance with follow-up clinics.
Conclusion: Approximately one in ten patients referred for upper GI endoscopy had a tumour in this series. Oesophageal cancer was a common endoscopic finding and only a small percentage (9.6%) was amenable to resection. Endoscopic stenting was found to be an affordable and effective minimally invasive outpatient procedure for palliation of dysphagia in non-resectable disease.
Key words: Oesophageal cancer, unsedated endoscopy, stenting (SEMS).
Conclusion: Approximately one in ten patients referred for upper GI endoscopy had a tumour in this series. Oesophageal cancer was a common endoscopic finding and only a small percentage (9.6%) was amenable to resection. Endoscopic stenting was found to be an affordable and effective minimally invasive outpatient procedure for palliation of dysphagia in non-resectable disease.
Key words: Oesophageal cancer, unsedated endoscopy, stenting (SEMS).
