Annals of African Surgery

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Oesophageal cancer and experience with endoscopic stent intubation at St. Mary’s Hospital, Nairobi

A.K Ndonga, M.R Rucha, R Oigara


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).
AJOL African Journals Online