Tu1074 A STEPWISE APPROACH TO IMPLEMENTATION OF ESOPHAGEAL STENTING FOR PALLIATION OF ESOPHAGEAL CANCER IN EAST AFRICA

There is a high incidence of esophageal squamous cell cancer (ESCC) in East Africa, where most patients present with advanced disease and severe dysphagia. Placement of self-expanding metal stents (SEMS) provides safe and effective palliation in resource-limited settings, but access to SEMS in Africa has been hampered by cost and lack of trained endoscopists. The aim of this report is to describe a regional initiative to increase SEMS access, launched by the African Esophageal Cancer Consortium (AfrECC). AfrECC has 1) identified an industry partner (Boston Scientific Corporation) committed to supplying affordable, high quality SEMS for placement by trained endoscopists, 2) worked to develop country specific and multi-national regulatory strategies for importation of SEMS, 3) created a modular training program for East African endoscopists with standardized assessments of competency to a) deploy SEMS and b) train other endoscopists in SEMS placement, and 4) established a device registry including data on patient outcomes. To date, 30 endoscopists at 7 hospitals in Kenya, Tanzania, Zambia and Malawi have been trained in deployment of the Ultraflex SEMS by 3 expert trainers. Six week-long training sessions have been held over 18 months. 252 SEMS have been placed in symptomatic patients during these sessions, using a non-fluoroscopic technique, without clinically significant adverse events. All 30 endoscopists achieved competence to place stents, and 11 endoscopists achieved competence as SEMS trainers. Teams of trainers in each country have now begun training additional endoscopists. SEMS are an important element of ESCC care in East Africa. A regional initiative to improve SEMS access can be effectively implemented, and requires partnership with industry and government stakeholders, as well as a modular training curriculum, standardized assessments, and pre-defined criteria for both stent placement competency and trainer competency. Patient outcomes data collected as part of a device registry may ultimately provide further validation of this initiative.