PURPOSE: Patients with locally advanced esophageal cancer requiring surgery usually suffer from significant to total dysphagia which causes them to be nutritionally depleted. Such patients need preoperative nutritional support in order to undergo successful surgery and recovery. The purpose of this study is to assess the benefit of stent placement across the tumor for nutritional support as a bridge to surgery and to determine subsequent post-operative outcomes.
METHODS: This is a prospective nonrandomized study of seven patients with locally advanced esophageal squamous cell carcinoma with total dysphagia presenting at Tenwek Hospital, Kenya between January 2008 and December 2010. 4 males and 3 females with mean age of 44 years were studied. All patients had self-expanding coated metallic stents placed across the tumor following flexible endoscope-assisted dilation. Main outcome measurements were improvement in patient nutritional status as measured by dysphagia score and weight gain, and peri-operative complications up to six months post-operative.
RESULTS: Instant dysphagia relief was achieved in all seven patients. Post-stent placement dysphagia score was reduced to 1 in all patients. The average weight gain was 1.4 kilograms per patient per week. Patients underwent esophagectomy on average 4.5 weeks after stent placement. No perforation, major bleeding, failure of recovery from anesthesia, post-operative anastomotic breakdown, or wound infection was observed in any of the patients.
CONCLUSIONS: Esophageal stent placement for nutritional support prior to esophageal resection for malignant disease allows resumption of oral feeding and weight gain, and may be beneficial for patients with severe dysphagia who are initially considered unfit for surgical intervention.
CLINICAL IMPLICATIONS: In a resource poor setting, esophageal stenting is a cost-effective and safe technique allowing improved nutrition and decreased short-term post-operative complications after esophagectomy.
DISCLOSURE: The following authors have nothing to disclose: Vincent Duron, Arega Fadeku, Russell White
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