Background Oesophageal cancer has a 5-year survival rate of 17%. Adequate symptom management is hence important at all stages of disease. Dysphagia, commonly experienced by these patients, can have a detrimental impact on quality of life. This can be managed by endoscopic insertion of an oesophageal stent aimed at improving symptoms. This procedure, however, is frequently associated with side effects, most notably chest pain.
Methods A literature review of the natural history of chest pain following insertion of oesophageal stent and management options was undertaken. Databases, including Medline and Embase, were searched using ‘o/esophageal stent’ and ‘stent/chest pain’ as well as associated terms. Some 160 articles were found. Non-relevant, non-English, and duplicate papers were discarded. Sixteen articles were retained and examined in detail, particularly regarding the incidence and management of stent-associated pain.
Results Chest pain following stent insertion is common, with reported incidence ranging from 9–60%. Often worse within the first 48 hours, this pain typically improves over time. Pain still requiring analgesia, however, has been reported over four weeks post-procedure. The most common treatment described is opioids. One study found that 40% of patients required an opiate to manage pain (mean daily dose of 43 mg). Overall the studies lacked detail about effective dosing regimens and long term follow up. The evidence for other treatment modalities was weak and often based on single case studies. These included radiotherapy, sublingual glyceryl trinitrate and, phrenic nerve block. Stent removal may be warranted, but is associated with risks of endoscopy and failure.
Conclusions Chest pain following oesophageal stenting is common and may persist despite treatment. Pain has a major impact on these patients‘ quality of life; effective management regimes are essential. Further studies are needed to evaluate long term consequences for patients and better explore appropriate therapeutic options for this symptom.
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