DO WE NEED X-RAY FOR ESOPHAGEAL STENTING ANYMORE?

Aims Evaluate the features and safety of ultrathin endoscope (UTE)-guidance esophageal stenting without fluoroscopy, and compare with standard techniques using X-rays.

Methods The study involved 326 patients from 2010 to 2019 (247M/79F, a mean age of 69).

A stent was placed by standard technique using X-rays in 40 patients (group A).

284 patients underwent UTE-guided SEMS placement without fluoroscopy (group B).

We used UTE with a diameter of 4.7 mm. Partially covered SEMS’s by one design from 80 mm to 140 mm in length were used.

Results In group A the endoscope diameter does not make it possible to pass through tight malignant stenosis. Risk of intraoperative complications increases, like damage of esophageal wall, the incorrect assessment of stenosis length . In case of strong stenosis it is required to perform preliminary bougienage or balloon dilation of the narrow lumen, that can also increase the risk of complications.

In B group enables pastights UCT-endoscope through malignant strictures, and assess their length precisely, if the lumen makes more than 4-5 mm . This technique does not necessitate utilizing X-ray for defining and marking proximal and distal tumor margins.

The guide wire under direct visualisationl is left in the stomach, which ensures the safety of the delivery system insertion. We provide UTE through the stent ‘waist’ immediately after its expansion and assess the distal flange position.

stenting timing - A-25min, B-12min,

X-ray duration (only A) - 3min,

technical errors

Wrong length of stent - A 17,5% B-0%;

necessary of stent reposition immediately after stenting - A-7,5%; B-0,7%

Conclusions UTE-guided SEMS placement without X-ray improves the conditions for precise stent positioning. It provides an opportunity to select stents individually with a minimal risk of complications for a patient and allows to control the stent installation process, which affects the technical success of stenting.