Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline

Introduction

Dysphagia and obstruction are among the most common indications for upper gastrointestinal endoscopy in African countries [1]. In a survey conducted by the European Society of Gastrointestinal Endoscopy (ESGE) International Affairs Working Group (IAWG), benign esophageal strictures as well as malignant upper gastrointestinal obstruction were reported as some of the most prevalent diseases leading to gastrointestinal endoscopy [1].

Management of esophageal obstruction may vary, depending on the cause of obstruction as well as the availability of resources. According to the ESGE original guideline, it could involve, for example, stent placement, radiotherapy/brachytherapy, or bypass surgery [2]. For resource-limited settings, however, a number of additional factors need to be considered before recommendations can be made. These involve economic considerations and resource availability. Furthermore, patients in low-resource settings presenting with malignant esophageal obstruction are often unfit for surgery due to presentation with advanced malignant disease as well as comorbidities such as HIV/AIDS and tuberculosis [3]. For such situations, self-expanding metal stents (SEMS) of the esophagus may provide a suitable palliative option [3] [4].

After the initial ESGE cascade guidelines on non-variceal upper gastrointestinal bleeding (NVUGIH), we aimed this ESGE cascade guideline to standardize management of esophageal stenting for benign and malignant disease in low-resource settings [2] [5].

• References

• 1 Hassan C, Aabakken L, Ebigbo A. et al. Partnership with African countries: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endosc Int Open 2018; 06: E1247-E1255
• 2 Spaander MC, Baron TH, Siersema PD. et al. Oesophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 939-948
• 3 Thumbs A, Vigna L, Bates J. et al. Improving palliative treatment of patients with non-operable cancer of the ooesophagus: training doctors and nurses in the use of self-expanding metal stents (SEMS) in Malawi. Malawi Med J 2012; 24: 5-7
• 4 Thumbs A, Borgstein E, Vigna L. et al. Self-expanding metal stents (SEMS) for patients with advanced oesophageal cancer in Malawi: an effective palliative treatment. J Surg Oncol 2012; 105: 410-414
• 5 Karstensen JG, Ebigbo A, Aabakken L et a. Nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline. Endosc Int Open 2018; 6: E1256-E1263
• 6 Milholland AV, Wheeler SG, Heieck JJ. Medical assessment by a Delphi group opinion technic. N Engl J Med 1973; 288: 1272-1275
• 7 Come J, Castro C, Morais A et a. Clinical and pathologic profiles of esophageal cancer in Mozambique: a study of consecutive patients admitted to Maputo Central Hospital. J Glob Oncol 2018; 4: 1-9
• 8 Mudawi HM, Mahmoud AO, El Tahir MA. et al. Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting. Dis Esophagus 2010; 23: 196-200
• 9 Thomas MO. Experience in oesophageal substitution in Lagos, Nigeria. Niger Postgrad Med J 2004; 11: 215-217