Using an exclusive endoscopic technique, the insertion of a Self-Expanding Metal Stent (SEMS) can be performed at any hospital equipped with standard endoscopy instruments, a study conducted by UKZN’s Dr Morganyagi Govender has found.
Titled: “Self-Expanding Metal Stent (SEMS) insertion: Fluoroscopy Versus Pure Endoscopic Technique – a Cost Comparison”, the study showed the pure endoscopic technique is associated with significant time and cost savings in comparison to the standard fluoroscopy technique.
‘SEMS, specifically designed for use inside the intestine, are made of nickel and titanium,’ said Govender, whose research focused specifically on SEMS’ use in oesophageal cancer, where instruments are inserted to allow patients to be able to swallow - specifically patients too ill for major surgery or chemotherapy.
SEMS in a compressed form are unravelled once placed inside the body. ‘They are inserted to relieve obstruction,’ said Govender. ‘There are different stents that can be used in different parts of the intestine.’
According to Govender, in South Africa, SEMS insertion is usually performed in tertiary centres using fluoroscopy. Fluoroscopy is a special X-ray screening which is performed at the same time as the endoscopy.
‘However, not all endoscopy centres in South Africa have fluoroscopy easily available. This means that patients requiring stenting must be transferred to other centres, resulting in delays and additional transport costs,’ said Govender. ‘At our institution, Greys Hospital in Pietermaritzburg, fluoroscopy is in great demand resulting in long delays before patients can be stented. We have therefore been using a different technique which does not require the use of fluoroscopy.’
She audited the SEMS technique over a five-year period and co-authored an article with Dr Damien Clark and Dr Coleen Aldous titled: “Self-Expanding Metal Stent Placement for Oesophageal Cancer Without Fluoroscopy is Safe and Effective”.
‘We showed our technique to be equivalent so the next research question was: “Can we show it to have advantages over the standard technique?” And that’s how the study came about.
‘It is hoped that by showing that our direct vision technique is safe, effective and cost efficient, we can pave the way for this procedure to become the standard practice in a resource constrained health system, like ours. This would allow the procedure to be performed at many regional centres and not be restricted to tertiary centres only, ultimately improving access to many patients who need this.’ Govender’s research papers formed part of her MMed Sci thesis.
She currently works at Greys Hospital in Pietermaritzburg as a Specialist Surgeon and is also a lecturer involved in both undergraduate and postgraduate teaching.
‘I hope to continue being part of the excellent surgical team at Greys and aim to make a difference to the study and management of oesophageal cancer in our country… one small step at a time, ‘she said.
She is passionate about her work. ‘My passion for my work keeps me going despite the long and demanding hours and the many years of studying and examinations! I always knew I wanted to be a surgeon, and I still can’t see myself doing anything else!’