ESOPHAGEAL STENTING FOR BENIGN AND MALIGNANT ESOPHGEAL PATHOLOGIES, EXPERIENCE OF FORGUT MULTIDISCIPLINARY REFERRAL CENTER
Tal Livne*, Eliahu Y. Bekhor, Olga Esepkina, Noam Peleg, Ory Wiesel
general surgery, Rabin Medical Center, Petah Tikva, Central, Israel
Introduction
Esophageal stenting is an established endoscopic treatment for esophageal obstruction or esophageal mucosal disruption due to various etiologies.
Data on its efficacy and outcomes varies among different series.
Our esophageal center is a dedicated multidisciplinary referral foregut center utilizing the strength of both interventional gastroenterologists and foregut surgeons.
Our primary goal was to investigate the outcomes of esophageal stenting for benign and malignant etiologies referred to our center utilizing our team approach. Our secondary goal was to find predictive factors for long term successful stent placement.
Methods
Retrospective data analysis of patients who underwent esophagogastroduodenoscopy (EGD) with esophageal stent placement for any etiology between January 2018 and December 2021. Based on the etiology, Patients were divided into 2 groups– esophageal lumen obstruction (ELO) and esophageal lumen disruption (ELD). Prior to each case, a dedicated multidisicplinary foregut conference was held in order to tailor the best approach (surgery vs endoscopic treatment) for each patient. Rates of stent failure (defined by stent migration, need for aditional endoscopic intevention or surgery), and 30, 90 day mortality were compared. A subgroup analysis of patients over the age of 70 years was further analyzed.
Results
54 patients underwent esophageal stenting during the study period. There were 36 males (66.7%), the cohort's mean age was 64.4 years. 37 patients (68.5%) received a stent for ELD and 17 patients (31.5%) had esophageal stent placed for ELO. Stent failure resulted in 32 patients (65.3%): 8 (47%) in ELO group and 24 (64.9%) in ELD group (p=0.746). 30-day mortality was 13% with 3 (17.6%) patients who died in ELO group and 4 (10.8%) who died in ELD group. 30-day survival was not significantly different between the ELO and ELD groups. (p=0.665). 90-day mortality was 29.6% with 7 patients (41.2%) who died in the ELO group and 9 patients (24.3%) who died in the ELD group. Overall survival rate between the groups was similar (p=0.191) (Fig. 1). In a multivariable analysis age over 70, male gender, BMI, diabetes and stent failure had no statistically significant effect on 90-day survival, active malignancy was found to be an independent predictor of death within 90-days from the procedure (HR=1.346). (table2)
In a subgroup analysis of elderly patients older than 70 years, 90-day mortality was not significantly different from the patients younger than 70 years. 26 patients (48.1%) older than 70 years of age had 8 deaths (30.77%) within 90 days from the procedure, wheras below 70 years there were 8 deaths (28.57%) (p=1.00).
Conclusion
Active malignancy is an independent predictor for 90-day mortality following esophageal stent placement. Neither age, obesity or nutritional status nor etiology can predict esophageal stent failure.
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