Khanzada Muhammad S, Salih Abdelmonim E A, Boland Michael R, Walsh Thomas N
Department of Surgery, Connolly Hospital Blanchardstown, Dublin 15, Ireland.
Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
Surg Endosc. 2022 Nov;36(11):8364-8370. doi: 10.1007/s00464-022-09295-7. Epub 2022 May 9.
Stenting is the management of choice for many benign and malignant oesophageal conditions and in the interest of safety stent insertion has traditionally been performed under fluoroscopic guidance. But this incurs additional expense, time, radiation risk and for the foreseeable future, an increased risk of Covid infection to patients and healthcare personnel. We describe a protocol that obviates the need for fluoroscopic guidance, relying instead on a systematic checklist to ensure safe positioning of the guidewire and the accurate positioning of the stent. The aim of this retrospective study was to review our experience of stent insertion employing a checklist system and compare our outcomes with outcomes using fluoroscopy in the literature.
We performed a retrospective review of a prospectively collected dataset of all patients undergoing oesophageal stent insertion between December 2007 and October 2019. The primary end points were patient safety parameters and complications of stent insertion.
Total of 163 stents were deployed of which 93 (57%) were in males and the median age was 67.9 years (25-92 years). Partially covered self-expanding metallic stents (SEMS) were used in 80% of procedures (130/163). One hundred nineteen stents (73%) were for malignant strictures and 127 (78%) were deployed for strictures in the lower third of the oesophagus. There was no stent misplacement, injury, perforation or death associated with the procedure. Vomiting was the main post-operative complication (14%). Severe odynophagia necessitated stent removal in 3 patients. Stent migration occurred in 17 (10%) procedures with a mean time to stent migration of 6.4 weeks (range 1-20 weeks).
Oesophageal stent placement without fluoroscopy is safe provided that a strict checklist is adhered to. The outcomes are comparable to the results of fluoroscopic stent placement in the literature, with considerable saving in time, cost, personnel, and risks of radiation and Covid exposure.
支架置入术是许多良性和恶性食管疾病的首选治疗方法，出于安全考虑，传统上支架置入术是在荧光透视引导下进行的。但这会产生额外的费用、时间、辐射风险，并且在可预见的未来，患者和医护人员感染新冠病毒的风险也会增加。我们描述了一种方案，该方案无需荧光透视引导，而是依靠系统的检查表来确保导丝的安全定位和支架的准确定位。这项回顾性研究的目的是回顾我们使用检查表系统进行支架置入术的经验，并将我们的结果与文献中使用荧光透视的结果进行比较。
我们对2007年12月至2019年10月期间所有接受食管支架置入术患者的前瞻性收集数据集进行了回顾性分析。主要终点是患者安全参数和支架置入术的并发症。
共置入163枚支架，其中93枚（57%）为男性，中位年龄为67.9岁（25 - 92岁）。80%的手术（130/163）使用了部分覆膜自膨式金属支架（SEMS）。119枚支架（73%）用于恶性狭窄，127枚（78%）用于食管下三分之一处的狭窄。该手术未发生支架误置、损伤、穿孔或死亡。呕吐是主要的术后并发症（14%）。3例患者因严重吞咽痛需要取出支架。17例（10%）手术发生支架移位，支架移位的平均时间为6.4周（范围1 - 20周）。
只要严格遵守检查表，无荧光透视的食管支架置入术是安全的。其结果与文献中荧光透视下支架置入术的结果相当，在时间、成本、人力以及辐射和新冠病毒暴露风险方面有可观的节省。
