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The Annals of African Surgery is the official publication of the Surgical Society of Kenya.

 

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ISSN (print): 1999-9674; ISSN (online): 2523-0816

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Oesophageal cancer and experience with endoscopic stent intubation at St. Marys Hospital, Nairobi

Author Information

Ndonga A.K., MBChB, MMed (Surg), FCS (ECSA), Rucha M.R., MBChB, MMed (Surg), FCS (ECSA) and Oigara R., MBChB, MMed (Surg), St Mary’s Mission Hospital, Nairobi, P.O. Box 3409-00506, Nairobi, Kenya

Corresponding author:

Dr. Ndonga A.K., P.O. Box 3409-00506, Nairobi, Kenya, Email: andrewndonga@hotmail.com

Abstract

Background: Oesophageal cancer often presents in advanced stages not amenable to surgical resection. In such patients, palliation of dysphagia remains the mainstay of management.

Objectives: To determine the burden of advanced oesophageal cancer and to document the experience with endoscopic metal stent intubation for its palliation

Design: Retrospective evaluation of upper gastrointestinal (GI) endoscopy data and prospective study of stented patients.

Setting: St Mary’s Mission Hospital, Nairobi, Kenya.

Subjects: Records of and patients who underwent upper gastrointestinal endoscopy and endoscopic stenting were evaluated .

Results: Between July 2000 and July 2007, 8580 upper GI endoscopies were carried out, revealing tumour in 796 patients (9.3%). Oesophageal cancer (both squamous cell and adenocarcinoma) accounted for 512 cases (64%), 328 (64%) being males. Only 49 (9.6%) of the oesophageal tumours were deemed amenable to and underwent resection with curative intent. One hundred self expanding metal stents (SEMS) procedures were carried out over a 17-month period (March 2006 – July 2007). Of these procedures, performed under topical anaesthesia and injectable analgesics, only seven involved re-stenting. All patients were able to swallow immediately after. Procedure-related mortality was 2%. Early procedure-related chest pain was a consistent feature (100%). At follow-up, over half of the patients (54%) had an objective weight gain before stabilizing or reducing as other tumour effects set in. The main study challenge was patient compliance with follow-up clinics.

Conclusion: Approximately one in ten patients referred for upper GI endoscopy had a tumour in this series. Oesophageal cancer was a common endoscopic finding and only a small percentage (9.6%) was amenable to resection. Endoscopic stenting was found to be an affordable and effective minimally invasive outpatient procedure for palliation of dysphagia in non-resectable disease.

Key words: Oesophageal cancer, unsedated endoscopy, stenting (SEMS).

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