Safety and efficacy of gastrointestinal stents in cancer patients at a community hospital

• Published in: Canadian Journal of Surgery Vol. 51; no. 2; pp. 130 - 134
• Main Authors: Baerlocher, Mark Otto, MD, Asch, Murray R., MD, Vellahottam, Andrew, MD, Puri, Gaurav, MD, Andrews, Karen, MD, Myers, Andy, MD
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 01-04-2008; CMA Impact, Inc; Canadian Medical Association
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Cancer patients; Colonic Neoplasms - mortality; Colonic Neoplasms - therapy; Duodenal Neoplasms - mortality; Duodenal Neoplasms - therapy; Effectiveness; Equipment Failure - statistics & numerical data; Equipment Safety; Esophageal Neoplasms - mortality; Esophageal Neoplasms - therapy; Esophageal Stenosis - mortality; Esophageal Stenosis - therapy; Female; Fluoroscopy; Follow-Up Studies; Gastrointestinal surgery; Health aspects; Hospital Mortality; Hospitals; Hospitals, Community - statistics & numerical data; Humans; Intestinal Obstruction - mortality; Intestinal Obstruction - therapy; Length of Stay - statistics & numerical data; Male; Middle Aged; Ontario; Original; Palliative Care; Patient safety; Postoperative Complications - etiology; Postoperative Complications - mortality; Radiology, Interventional; Safety and security measures; Stent (Surgery); Stents; Surgery; Survival Rate; Treatment Outcome; Ontario; Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1016/S0008-428X(08)50030-0

Objective Increasing scientific evidence supports the use of self-expanding metallic gastrointestinal (GI) stents. The commonly accepted primary indications are their usefulness as a bridge to surgery and for palliation to avoid surgery. These stents have been shown to have high technical success and low complication rates, leading to improved quality of life for patients. They have also been shown to be cost-effective when compared with alternative therapies. The objective of this study is to present a retrospective review of our local experience. Methods Attempts were made to place 23 GI stents in 16 patients for palliative cancer indications. Results Follow-up was 5–352 days (mean 81.9 d). Presenting symptoms included abdominal distention or pain (81%), nausea or vomiting (69%), constipation (31%) and weight loss (19%). Stents were placed in the colon (11 patients), duodenum (4 patients) or esophagus (1 patient). The technical success rate was 91.3%, the clinical success rate (defined as any improvement in symptoms in patients successfully receiving a stent) was 85.7%, and the complication rate was 21.4% among patients successfully receiving a stent, or 18.8% overall. Of 14 patients successfully receiving at least 1 stent, 10 (71%) were discharged home after a mean of 11.5 days (range 1–26 d). Of patients successfully receiving at least 1 stent, 12 (86%) had passed away at the time of last follow-up. Patients who successfully received a stent but who have since passed away (either in hospital or out of hospital) had their stent(s) in situ for a mean of 57 days (range 5–180 d). Conclusion On the basis of our data, we believe that GI stents may be safely and effectively used in a community hospital setting and that they provide benefit in the palliative care population.