van Hooft J, Mutignani M, Repici A, Messmann H, Neuhaus H, Fockens P
Academic Medical Center, Amsterdam, The Netherlands.
Endoscopy. 2007 May;39(5):434-9. doi: 10.1055/s-2007-966338.
Gastric outlet obstruction can occur as a late complication of a variety of cancers. Palliation of the obstructive symptoms is the primary aim of treatment in these patients. Self-expandable metal stents have emerged as a promising treatment option. The purpose of this study was to investigate the short-term (30-day) clinical success and complication rates of a new enteral stent made of nitinol (Boston Scientific WallFlex stent).
Between December 2004 and 1 May 2005, 62 patients (35 men, 27 women; mean age 69.9 years) presenting with documented malignancy and symptoms of gastric outlet obstruction underwent endoscopic stenting with the new WallFlex enteral stent at one of the 15 European centers who were the first to have access to this new stent. Data were collected from charts, endoscopy procedure reports, and follow-up clinical visits. The gastric outlet obstruction scoring system (GOOSS) was used to grade the patients' ability to eat.
All 62 patients suffered from nausea, vomiting, or inability to eat. A total of 66 enteral stents were placed. The median length of the stenosis was 4 cm. The clinical success rate was 85% on an intention-to-treat basis. An improvement in the GOOSS score of 1 point was considered to be significant (P < 0.001). Oral intake was possible, on average, 1 day after stent placement. The median hospital stay was 6 days. Thirty days' follow-up data were available for 60 patients, 10 of whom developed complications during this period (17%).
In this first European series in which duodenal stenting was performed with the WallFlex enteral stent, the new stent appears to be effective and relatively safe for the palliative treatment of patients with malignant gastric outlet obstruction.
胃出口梗阻可作为多种癌症的晚期并发症出现。缓解梗阻症状是这些患者治疗的主要目的。自膨式金属支架已成为一种有前景的治疗选择。本研究的目的是调查一种新型镍钛合金制成的肠内支架（波士顿科学公司的WallFlex支架）的短期（30天）临床成功率和并发症发生率。
2004年12月至2005年5月1日期间，62例（35例男性，27例女性；平均年龄69.9岁）有记录的恶性肿瘤且伴有胃出口梗阻症状的患者，在15个欧洲率先获得这种新型支架的中心之一，接受了使用新型WallFlex肠内支架的内镜下支架置入术。数据从病历、内镜检查报告和随访临床就诊中收集。采用胃出口梗阻评分系统（GOOSS）对患者的进食能力进行分级。
所有62例患者均有恶心、呕吐或无法进食的症状。共置入66个肠内支架。狭窄的中位长度为4厘米。意向性治疗分析的临床成功率为85%。GOOSS评分提高1分被认为具有显著意义（P<0.001）。支架置入后平均1天即可经口进食。中位住院时间为6天。60例患者有30天的随访数据，其中10例在此期间出现并发症（17%）。
在欧洲首个使用WallFlex肠内支架进行十二指肠支架置入的系列研究中，这种新型支架对于恶性胃出口梗阻患者的姑息治疗似乎有效且相对安全。
