Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

Introduction: This study assesses the efficacy of self-expandable metal stents (SEMS) in palliating dysphagia among patients with oesophageal cancer. Despite potential complications, SEMS emerges as a preferred option in palliative care world-wide.
Methods: A prospective cohort study over one year period among 80 patients with inoperable oesophageal carcinoma considered for palliative treatment and referred for SEMS to relieve the malignant dysphagia. All the stenting were performed by a single Gastro enterologist (ANR). Mellow-Pinkas scoring system was used to assess the efficacy.
Results: The mean age of the patients was 66 years with majority of them being male (60%, n=48). A substantial proportion of tumors were in the middle third of the esophagus (57.5%, n = 46). Notably, 53% of patients (n=42) reported exclusive liquid swallowing ability, while 27% (n=22) could swallow semi-solid foods, and 20% (n=16) experienced complete dysphagia. The technical success rate of the intervention was 100%, with a noteworthy 98.8% (n=79) of patients reporting an improvement. However, clinical success, defined by the achievement of improved swallowing function, was observed in only 63.7% (n=51) of cases. Despite a statistically significant average reduction of 1.7 points in the dysphagia scoring system (range 0-3) (p<0.001), tumor location did not emerge as a significant factor influencing clinical success (p>0.05). Procedure related complications were rare.
Conclusion: Fully covered self-expanding metal stent is a safe and an effective method of palliation of an intolerable symptom in oesophageal carcinoma patients. Life threatening complications were rare. Further improvements to the quality of stents may help reduce the number of complications and enhance the quality of life of patient.