Long Term Outcome in Patients with Esophageal Stenting for Cancer Esophagus - Our Experience at a Rural Hospital of Punjab, India

Double hitch stitch is a novel technique for fixation of tracheal stent in a case of tracheoesophageal fistula: a case report

Background

Caudal tracheal stent migration can be potentially life threatening by causing distal luminal obstruction. We present a rare double hitch stitch procedure (for prevention of migration of tracheal stent), which is an external fixation technique in a case of tracheoesophageal fistula with tracheal and esophageal self-expandable metallic stent (SEMS).

Case presentation

A 50-year-old male patient who presented with cough and dyspnea was a known case of carcinoma of the esophagus with esophageal stent in situ. Computed tomography (CT) scan showed tracheoesophageal fistula with esophageal stent (esophageal SEMS) migrating into the trachea. Tracheal stenting was done with SEMS. Patient was followed up after 1 month with recurrent complaints of cough on deglutition. On follow-up bronchoscopy, migration of stent was observed. A rare procedure of double hitch stitch was performed with fixation of the tracheal stent (tracheal SEMS) using a percutaneous anchoring stitch, embedded in the subcutaneous tissue. Follow-up bronchoscopy after 1 month of the procedure showed no migration of stent.

Conclusion

For the treatment of large tracheoesophageal fistula, stenting of both the trachea and the esophagus along with the double hitch stitch proved to be lifesaving. Stent migration prevention using “double hitch-stitch” is simple, safe, and successful, without any complications.

Recurrence of Obstructive Symptoms and Quality of Life after Insertion of Non-Cover Metal Stent Inside the Biliary Duct in Patients with Pancreatic Cancer

Background: Quality of disease is improved in patients with pancreatic cancer via endoscopic placement of a biliary stent. Since the role of non-cover metal stent inside the biliary duct is not definitely clear, the aim of this study was to evaluate the recurrence of obstructive symptoms and quality of life after insertion of non-cover metal stent inside the biliary duct in patients with pancreatic cancer. Methods: This retrospective descriptive-analytical study was conducted on 81 patients with pancreatic cancer who were referred to Mortaz and Shahaid Sadoughi Hospital. Factors such as pruritus, jaundice, appetite, stomachache and general situation were measured. Quality of life assessment was performed using the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire (version 4). Then, the quality of life score was classified in terms of median score (more and less than 18). Results: Patients had a mean age of 72±12.15 years. The most complete recovery among them was related to jaundice (54.3%) and pruritus (47.4%). Subjects had a mean quality of life score of 21.60±6.24. Moreover, the mean quality of life score of 37.2% and 62.8% of patients was less and more than the median value, respectively. In addition, there was no significant difference between frequency of recurrence in terms of variables including sex, age, death, chemotherapy, surgery, and quality of life (p>0.05). The mean recurrence time was 6.9±5.03 months. Conclusion: According to our findings, the quality of life score of most patients using metal stent is higher than 18. Therefore, it seems that the use of metal stent can improve the quality of life score in these patients. Stenting also improves jaundice and pruritus in these subjects. In addition, because there is no significant relation between the frequency of recurrence with age, mortality, chemotherapy, and quality of life, it can be concluded that none of the above factors affects the frequency of recurrence among patients with pancreatic cancer.

Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population

PURPOSE OF REVIEW

This review aims to synthesise the current literature on the management of early-stage and metastatic esophageal cancers, focusing on the older population. In particular, we aim to dissect out the elderly-specific data from the relevant trials and to discuss the issues unique to this population.

RECENT FINDINGS

While surgery is the curative modality in esophageal malignancies, the CROSS, MAGIC and FLOT trials demonstrate a clear advantage to neoadjuvant therapy (chemotherapy and chemoradiotherapy). These trials, however, included few elderly patients. There is a similar lack of elderly-specific data in the metastatic setting. Esophageal malignancies remain highly lethal with increasing incidence with age. Despite the relative lack of elderly-specific data, the fit older population appear to similarly benefit from multimodal therapy in early-stage and palliative therapy in metastatic disease.

Investigating Esophageal Stent-Placement Outcomes in Patients with Inoperable Non-Cervical Esophageal Cancer

Background: Esophageal stent insertion in patients with inoperable esophageal cancer is usually accompanied with relatively high adverse symptoms and even mortality. The current study aims at investigating the outcomes of esophageal stenting in patients with inoperable non-cervical esophageal cancer. Materials and Methods: The current descriptive-analytical research evaluates 25 patients with esophageal cancer. The stent was placed in esophagus based upon endoscopy analysis with or without fluoroscopy and then the stent position and its opening was investigated by making use of CXRand Gastrografin studies. Demographic characteristics, dysphagia scores, stent placement side effects and the dysphagia-related indices were recorded and examined by taking advantage of a questionnaire which was administered pre and post stent insertion. Results: The study population was comprised of 15 women and 10 men. The individuals' average age was 69.20 ± 11.25 years. Dysphagia mean score was lowered from a value of 4.32 ± 0.80 to 2.00 ± 1.22 (P-value<0.05). The prevalent side effects were chest pain (64%), dysphagia recurrence (40%), stent blockage (20%), stent migration (16%), GI bleeding (8%), and malposition (8%). Also, it was found out that 64% of the patients survived for 6 months. Conclusion: The results indicated that although esophageal stenting is accompanied with side effects in patients with inoperable esophageal cancer, but it is the most frequently used and the most reliable method in relieving dysphagia and improving dysphagia-related life indices.

The Role of Affordable, Point-of-Care Technologies for Cancer Care in Low- and Middle-Income Countries: A Review and Commentary

As the burden of non-communicable diseases such as cancer continues to rise in low- and middle-income countries (LMICs), it is essential to identify and invest in promising solutions for cancer control and treatment. Point-of-care technologies (POCTs) have played critical roles in curbing infectious disease epidemics in both high- and low-income settings, and their successes can serve as a model for transforming cancer care in LMICs, where access to traditional clinical resources is often limited. The versatility, cost-effectiveness, and simplicity of POCTs warrant attention for their potential to revolutionize cancer detection, diagnosis, and treatment. This paper reviews the landscape of affordable POCTs for cancer care in LMICs with a focus on imaging tools, in vitro diagnostics, and treatment technologies and aspires to encourage innovation and further investment in this space.