Safe oesophageal stent deployment using a checklist system instead of fluoroscopy

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Medical Device Technology

Background:

• Esophageal stenting is crucial for benign and malignant conditions.
• Traditional fluoroscopic guidance poses risks: cost, time, radiation, and infection (e.g., COVID-19).
• A novel checklist-based protocol aims to eliminate fluoroscopy for esophageal stent insertion.

Purpose of the Study:

• To evaluate the safety and efficacy of a checklist-guided esophageal stent insertion protocol.
• To compare outcomes of non-fluoroscopic stenting with literature data on fluoroscopic methods.
• To assess the feasibility of reducing procedural risks and costs.

Main Methods:

• Retrospective review of prospectively collected data (December 2007 - October 2019).
• Analysis of 163 esophageal stent insertions using a systematic checklist protocol.
• Primary endpoints: patient safety parameters and procedural complications.

Main Results:

• 163 stents deployed (80% partially covered SEMS); 73% for malignant strictures.
• No instances of stent misplacement, injury, perforation, or procedure-related death.
• Key complications: vomiting (14%), stent migration (10%), and severe odynophagia requiring removal (3 patients).

Conclusions:

• Esophageal stent placement without fluoroscopy is safe with strict checklist adherence.
• Outcomes are comparable to fluoroscopic methods, offering significant savings in time, cost, and risk.
• This approach mitigates radiation and infection exposure for patients and staff.