Complications of Fluoroscopy Guided Oesophageal Self Expanding Metal Stent Insertion.
Monitoring complication rates of fluoroscopy guided oesophageal self expanding metal stent insertion.
Insertion of self-expanding metal stents is widely practised in the palliation of malignant oesophageal strictures, and to a lesser extent in the treatment of benign strictures refractory to standard therapy, when retrievable stents are employed [1]. The technique is regarded as safe and effective, providing rapid relief of symptoms [2]. However complications can occur, such as stent migration, haemorrhage, perforation/fistula formation and tumour overgrowth [3]. Therefore, it is important to review the procedure of stent insertion along with any subsequent complications, and compared with data from the literature.
The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) guidelines for placement of oesophageal stents [3].
The frequencies of complications caused by implantation of self expanding metal stents as reported by these guidelines are as following:
Haemorrhage 3-8 %
Prolonged chest pain 14 %
Migration: uncovered stent 0-6 %
Migration: covered stent 25-32 %
Overgrowth 60 %
Tumor ingrowth: uncovered stent 17-36 %
Tumor ingrowth: covered stent Negligible
Fistula Uncommon
Perforation Uncommon
Death 0–1.4 %
Complication rates should not exceed the figures reported by CIRSE guidelines.
-
The indicator
The frequencies of complications occurring with fluoroscopy- guided oesophageal self expanding metal stent insertion.
-
Data items to be collected
Records of the procedure performed and its recognised complications. This can be obtained using the Upper Gastrointestinal Multi Disciplinary Team data, as well as data from the Radiology CRIS and PACS systems.
-
Suggested number
All procedures of stent insertion performed during a one-year period.
• Modify the technique of the procedure or undertake re-training.
• Review the adequacy and quality of the stents.
• Re-audit following change to maintain standards.
appendix
• Complication rates according to the CIRSE guidelines.
• Complication rates according to the American Guidelines.
• Other published complications.
1. Sharma P, Kozarek R and the Practice Parameters Committee of the American College of Gastroenterology. Role of Esophageal Stents in Benign and Malignant Diseases. Am J Gastroenterol 2010; 105:258–273.
2. Sreedharan A, Harris K, Crellin A, Forman D, Everett SM. Interventions for dysphagia in oesophageal cancer. Cochrane Database of Systematic Reviews 2009, Issue 4.
3. Sabharwal T, Morales JP, Irani FG, et al. Quality Improvement Guidelines for Placement of Esophageal. Cardiovasc Intervent Radiol (2005); 28:284–288.
For further information with regards to published complications of oesophageal self expanding metal stent insertion, please refer to appendix in resources.
Dr Mohammed Nabi, Dr Jane Phillips-Hughes, Dr Mark Bratby, Dr Suzie Anthony and Dr Raman Uberoi
14 February 2011