Wigginghaus B, Dormann A J, Grünewald T
Medizinische Klinik, Klinikum Minden.
Z Gastroenterol. 1999 Nov;37(11):1093-9.
Malignant gastric outlet obstructions are commonly present in an advanced tumor stage. Surgery and other therapy options are often accompanied with substantial problems and reduced quality of life. We therefore investigated the endoscopic palliation with self-expandable metallic stents. This report documents the clinical benefit of new stent systems. During a period of eleven months we implanted eleven self-expandable metallic stents (one Ultraflex Esophageal Stent/five Ultraflex Duodenal Diamond Stents/five Enteral Wallstents) in eight patients with malignant gastric outlet stenoses (five female/three male, average age 66 years, range 42-85 years). The procedure was performed under analgosedation and in seven cases on an outpatient bases. The stenosis could be dilated in all cases without complications, allowing semi-liquid oral feeding at the procedure day. Three patients needed a second stent in the follow-up. Stent dislocation appeared in one case after one month--the stent protruded per vias naturales. The stent struts broke in two patients after one and four months post stent implantation. A new stent could be inserted without complications in both cases. The used products enabled a fast and precise positioning of the metallic stent in malignant gastric outlet stenosis. We experienced some problems with the Ultraflex Duodenal Diamond Stent. This didn't occur with the Enteral Wallstent. Additionally with the Enteral Wallstent we could solve the diamond stent complications. Due to the small diameter (10 French) the Enteral Wallstent system can be positioned wire guided in the stenosis through the working channel of the endoscope. Stent release is performed fluoroscopically and with the use of endoscopic guidance retaining the instrument in the stomach. In our point of view, this metallic stent is an optimal device for the palliative treatment of malignant gastric outlet obstructions.
恶性胃出口梗阻常见于肿瘤晚期。手术和其他治疗方案常常伴随着诸多严重问题，且生活质量下降。因此，我们研究了自膨式金属支架的内镜下姑息治疗。本报告记录了新型支架系统的临床益处。在11个月的时间里，我们为8例恶性胃出口狭窄患者（5例女性/3例男性，平均年龄66岁，范围42 - 85岁）植入了11个自膨式金属支架（1个Ultraflex食管支架/5个Ultraflex十二指肠菱形支架/5个肠道Wallstent支架）。该操作在镇痛镇静下进行，7例为门诊手术。所有病例狭窄均能成功扩张且无并发症，术后当日即可经口进食半流质食物。3例患者在随访中需要植入第二个支架。1例患者在术后1个月出现支架移位——支架经自然通道突出。2例患者分别在支架植入后1个月和4个月出现支架支柱断裂。这两例均顺利植入新支架且无并发症。所使用的产品能够在恶性胃出口狭窄中快速、精准地定位金属支架。我们在使用Ultraflex十二指肠菱形支架时遇到了一些问题，而使用肠道Wallstent支架则未出现此类情况。此外，使用肠道Wallstent支架我们能够解决菱形支架的并发症问题。由于其直径较小（10F），肠道Wallstent系统可通过内镜工作通道在导丝引导下放置于狭窄部位。支架释放通过荧光镜检查并在内镜引导下进行，同时将器械保留在胃内。在我们看来，这种金属支架是恶性胃出口梗阻姑息治疗的理想器械。
