Abstract 1412P
Background
Endoscopic stent placement is a common intervention to improve dysphagia in patients with GOC but post-procedural complications and prognosis post insertion have not been reliably described.
Methods
From an electronic medical record, patients with stent placement from 24/6/2015 to 30/3/2020 were identified. Demographic, clinical and outcome data were extracted. Significant post-stent adverse events (pain, bleeding, perforation, arrhythmia and refractory reflux/vomiting) were classified as acute (<7 days) or delayed (≥ 8 days). Overall survival (OS) was from stent placement to death or last follow up. Survival curves for relevant variables were compared using log-rank test and Kaplan Meier method.
Results
150 patients were identified: median age 76 years, 76% were male. Histology: 17% squamous, 76% adenocarcinoma and 7% other. Tumour site:10% gastric, 21% GOJ and 69% oesophageal cancer. Disease burden was metastatic in 44% and locally advanced in 56% of the patients. 43% patients received anticancer treatment before and 12% after stent; 19% had 2nd stent and 2% a 3rd one. 7% had an acute, 58% delayed and 1.3% severe complications (1 perforation and 1 arrhythmia). Median OS in the population was 3.4m (months) (2.8 – 3.9, CI 95%). Treatment post-stent was associated with a higher survival (10.2m, 7.1 – 13.3 CI 95%) than no treatment (3.0m, 2.3 – 3.7 CI 95%, p<001). Dysphagia improvement was also associated with improved survival (3.8m vs 2.5m, p=0.009) and immediate complications were associated with poor survival (1.7m vs 3.6m, p=0.008). Gender, tumour subtype, anatomical site, treatment pre-stent and delayed complications were not associated with survival. Patients who had a 2nd and 3rd stent placed had a higher survival than one stent, respectively (10.35m, 9.61 – 11.09 CI 95% vs 2.74m, 2.11 – 3.37 CI 95%, p<0.001) and (17.11m, 6.92 – 27.30 CI 95% vs 3.31m, 2.75 – 3.87 CI 95%, p=0.04).
Conclusions
Stent placement is a valuable treatment for patients with GOC dysphagia. Cancer treatment post-stent, dysphagia improvement and no acute complications are associated with better survival. Patients who require and who are fit for a second stent appear to have good survival, favouring a repeat stent placement in selected cases.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
E. Smyth: Non-Financial Interests, Institutional, Advisory Board, Travel: Astellas; Non-Financial Interests, Institutional, Advisory Board, Travel: AstraZeneca; Non-Financial Interests, Institutional, Advisory Board, Travel: BMS; Non-Financial Interests, Institutional, Advisory Board: Five Prime; Non-Financial Interests, Institutional, Advisory Board: Gritstone Therapeutics; Non-Financial Interests, Institutional, Advisory Board: Merck; Non-Financial Interests, Institutional, Advisory Board, Travel: Servier; Non-Financial Interests, Institutional, Advisory Board: Zymerworks. All other authors have declared no conflicts of interest.