Shim C S, Jung I S, Cheon Y K, Ryu C B, Hong S J, Kim J O, Cho J Y, Lee J S, Lee M S, Kim B S
Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, South Korea.
Endoscopy. 2005 Apr;37(4):335-9. doi: 10.1055/s-2005-861113.
When stents are placed across the esophagogastric junction for palliative treatment of malignant strictures, they may lead to esophagogastric reflux. The aim of this study was to compare the effectiveness of a newly designed antireflux stent with that of a standard open stent and a currently available antireflux stent (Dostent) in preventing gastroesophageal reflux symptoms in patients with inoperable cancer at the esophagogastric junction.
Thirty-six consecutive patients with cancer at the esophagogastric junction were randomly assigned to undergo placement of a newly designed antireflux stent (n = 12), a Dostent (n = 12), or a standard open stent (n = 12). Technical and clinical success, dysphagia score, reflux symptoms, complications and ambulatory 24-h esophageal pH monitoring were assessed.
The technical success rates were 100 %. After 1 week, dysphagia had improved in all patient groups ( P < 0.05), but the degree of improvement did not differ between the three groups. The DeMeester score was significantly lower in the group with the newly designed antireflux stent than in the other groups. The fraction of the total recording time during which esophageal pH was below 4 was 3.14 +/- 5.78 % using the newly designed antireflux stent, in comparison with 29.25 +/- 15.41 % in the Dostent group and 15.01 +/- 11.72 % in the standard open stent group ( P < 0.001). Fewer reflux episodes occurred with the newly designed antireflux stent than with the Dostent or standard open stent. There were no complications with any of the three stents.
The newly designed antireflux stent is effective in relieving dysphagia caused by malignant cancer at the esophagogastric junction. The newly designed antireflux stent is significantly more effective in preventing gastroesophageal reflux than currently available antireflux stents.
当在食管胃交界处放置支架以姑息治疗恶性狭窄时，可能会导致食管胃反流。本研究的目的是比较一种新设计的抗反流支架与标准开放式支架以及目前可用的抗反流支架（Dostent）在预防食管胃交界部无法手术的癌症患者胃食管反流症状方面的有效性。
36例连续的食管胃交界部癌症患者被随机分配接受新设计的抗反流支架置入（n = 12）、Dostent支架置入（n = 12）或标准开放式支架置入（n = 12）。评估技术成功率、临床成功率、吞咽困难评分、反流症状、并发症以及动态24小时食管pH监测情况。
技术成功率均为100%。1周后，所有患者组的吞咽困难均有改善（P < 0.05），但三组之间的改善程度无差异。新设计的抗反流支架组的DeMeester评分显著低于其他组。使用新设计的抗反流支架时，食管pH低于4的总记录时间比例为3.14±5.78%，而Dostent支架组为29.25±15.41%，标准开放式支架组为15.01±11.72%（P < 0.001）。新设计的抗反流支架发生的反流事件少于Dostent支架或标准开放式支架。三种支架均未出现并发症。
新设计的抗反流支架可有效缓解食管胃交界部恶性肿瘤所致的吞咽困难。新设计的抗反流支架在预防胃食管反流方面比目前可用的抗反流支架显著更有效。
