The use of the paediatric gastroscope to deploy self-expanding metal stents in patients with cancer of the oesophagus at Dr. George Mukhari Academic Hospital

Neha Kumar, Moses A. Balabyeki, Imraan I. Sardiwalla, Yaeesh Sardiwalla, Modise Z. Koto


Background: Oesophageal carcinoma continues to be a major cause of cancer related deaths worldwide. Metal stents are an established treatment option for palliation of dysphagia. These stents are classically deployed using endoscopy with fluoroscopic control. An alternative technique is using the paediatric endoscope.

Methods: The study is a retrospective review of all cases of esophageal stenting at Dr George Mukhari Academic Hospital, Pretoria, South Africa were included. A prospectively maintained database Olympus Endobase® is used in the endoscopy suite. All cases between March 2015- February 2018, where the oesophagus was stented were reviewed. Cases where the paediatric scope was used were analysed further. Data captured from the database included demographics, tumour length, the presence of trahceoesophageal fistula.

Results: A total of 233 patients were stented, the paediatric scope was used in 217. The procedure was successfully completed in 84,7% of the patients. Repeat stenting was required in 20 patients. The mean age was 57 years (32-97). Average length of the stricture 9,6cm (5-15cm). The reasons for palliation were patient unfit for surgery (n=159), associated TOF (n=15), unspecified (n=38). The reasons for repeat stenting were stent migration (n=5), tumour overgrowth (n=10) and blocked stent (n=5). Complications were recorded in 1 case where an iatrogenic perforation was caused which was successfully stented. In the 33 cases that failed the reason for failure was inability of the scope to negotiate the stricture. These cases were subsequently completed successfully using a guidewire with fluoroscopy. There was no periprocedural mortality.

Conclusions: It is safe and feasible to use the paediatric endoscope to stent tumours of the oesophagus. If the procedure is successful it prevents the exposure of the staff and the patient to radiation. It ensures reliable placement of the guidewire into the stomach as well as confirming appropriate positioning of the stent.


Oesophageal cancer, Paediatric Gastroscope, Stenting

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Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Lancet. 2009 Sep 12;374(9693):934-47.

Coyle WJ, Lawson JM. Malignant dysphagia: palliation with esophageal stents-long-term results with 100 patients. Gastrointest Endosc. 1999;50:134-5.

Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Annals Thoracic Surg. 2001 Jun;71(6):1797-802.

de Boer WA, van Haren F, Driessen WM. Marking clips for the accurate positioning of self-expandable esophageal stents. Gastrointest Endosc. 1995;42:73-6.

Lam YH, Chan A, Lau J, Lee D, Ng E, Wong S, et al. Self expandable metal stents for malignant dysphagia. Australian New Zealand J Surg. 1999;69:668-71.

Austin AS, Khan Z, Cole AT, Freeman JG. Placement of esophageal self-expanding metallic stents without fluoroscopy. Gastrointest Endosc. 2001 Sep;54(3):357-9.

Wilkes EA, Jackson LM, Cole AT, Freeman JG, Goddard AF. Insertion of expandable metallic stents in esophageal cancer without fluoroscopy is safe and effective: A 5-year experience. GI Endoscopy. 2007;65(6):923-9.

Dobrucali A, Caglar E. Palliation of malignant esophageal obstruction and fistulas with SEMS. World J Gastroenterol. 2010;16(45):5739-45.

Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF, et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: Short-term and long-term follow-up. Ann Thorac Surg. 2001;71(6):1797-1801.

Cwikiel W, Tranberg KG, Cwikiel M, Lillo-Gil R. Malignant dysphagia: Palliation with oesophageal stents. Radiology. 1998;207(2):513-8.

Soussan EB, Antonietti M, Lecleire S, Savoye G, Di Fiore F, Paillot B, et al. Palliative esophageal stent placement using endoscopic guidance without fluoroscopy. Gastroenterol Clin Biol. 2005;29(8-9):785-8.

White RE, Mungatana C. Esophageal stent placement without fluoroscopy. Gastrointest Endosc. 2001;53(3):348-51.

Govender M, Aldous C, Ferndale L, Thomson SR, Clarke DL. Self-expanding metal stent placement for oesophageal cancer without fluoroscopy is safe and effective. S Afr Med J 2015;105(10):858-61.