ESOPHAGEAL BALLOON DILATATION AND STENTING UNDER DIRECT VISION FOR IMPASSABLE MALIGNANT STRICTURES: A SINGLE CENTRE EXPERIENCE

Aims To evaluate the safety & efficacy of the combined technique of balloon dilatation & placement of self expandable metallic stents (SEMS) in patients with malignant impassable esophageal obstruction under direct vision.

Methods Balloon dilatation and SEMS were placed under direct vision without using fluoroscopic guidance in patients suffering from advanced and non-resectable esophageal cancer between November 2014 and July 2018. All procedures were performed under conscious sedation by a single operator. Patients with standard gastroscope passable esophageal obstruction were excluded. Patients’ electronic records files were reviewed retrospectively to obtain data on success rate, dysphagia score (DS) improvement, stent migration rates, adverse events (AE) and mortality rates (MR) for proximal release partially covered SEMS. Patients’ long-term survival was assessed using the Kaplan-Meier method.

Results A total 64 procedures were performed on 55 patients. SEMS were successfully deployed following 8-10mm CRE balloon dilatation in 49 patients (49/55, 89% success) without using fluoroscopic guidance. 6 (11%) procedures were unsuccessful and required repeat procedure under fluoroscopic guidance. DS improved in 46 of 49 patients (93%). The median DS decreased from 3 to 2 (P< 0.0001). The overall stent migration rate was 6% (3/49) and required repeat stenting. 45/49 (91%) were discharged home the same day. No major complications or stent related deaths were reported.

Conclusions Oesophageal stenting can be done safely and successfully without using fluoroscopy in most cases of impassable malignant strictures following careful dilatation with a small size CRE balloon.