Self-Expandable Metal Stent for Palliation of Dysphagia in Cancer Esophagus at a Tertiary Care Center of North-East India: A Prospective Study.

Abstract

Background and Aim: Esophageal cancer is the sixth most common cancer in India with a incidence of around 4.5%. Dysphagia is the primary manifestation of advanced esophageal cancer in 80%-90% of patients. Dysphagia is one of the most distressing and debilitating symptom for the patients. The use of self-expanding metallic stents (SEMS) has revolutionized the treatment of dysphagia in esophageal cancer patients. This study aims to assess the role of SEMS in the palliation of dysphagia in patients with esophageal cancer. Methods: This was a single-center, prospective observational study conducted in the Department of Surgical Oncology at Dr. B. Borooah Cancer Institute in Guwahati, India, from April 2019 to March 2020. Patients were assessed after stent placement for improvements in dysphagia, pain relief, nutritional status, and associated complications. Results: One week after stent placement, 65.3% of patients were able to tolerate semisolid food and 6.1% could tolerate solids. Prior to stent insertion, 87.8% had Grade 4 dysphagia, but at 6 months post-SEMS placement, 90.2% had only Grade 1 dysphagia. This represented a statistically significant improvement in the dysphagia grade, with a p value less than 0.0001. Further analysis using ANOVA and paired t-tests showed significant improvements in weight, body mass index (BMI), and serum albumin at 1, 3, and 6 months after stent placement, with p values less than 0.001. Conclusion: The results of this study demonstrated that the placement of SEMS is a safe and effective palliative intervention for management of dysphagia in carcinoma esophagus, leading to improvements in patient nutrition and quality of life, with relatively few associated complications.