Repici Alessandro, De Caro Giuseppe, Luigiano Carmelo, Fabbri Carlo, Pagano Nico, Preatoni Paoletta, Danese Silvio, Fuccio Lorenzo, Consolo Pierluigi, Malesci Alberto, D'Imperio Nicola, Cennamo Vincenzo
Milano, Bologna, Italy.
Gastrointest Endosc. 2008 Jan;67(1):77-84. doi: 10.1016/j.gie.2007.08.019.
Self-expanding metal stents (SEMSs) can alleviate malignant colonic obstruction and avoid emergency decompressive surgery. The use of colonic larger-diameter SEMSs may improve bowel function and reduce migration risk.
To evaluate the effectiveness and safety of a novel large-diameter SEMS (WallFlex) designed for delivery through the endoscope in treating malignant colonic obstruction.
Prospective clinical cohort study.
Two Italian study centers.
Forty-two consecutive patients with malignant colonic obstruction: 23 requiring palliation and 19 bridging to surgery.
Colorectal SEMS placement.
Technical success, defined as accurate SEMS deployment across the stricture on the first attempt; clinical success, ie, complete relief of bowel obstruction without complications; and bridging to surgery, denoting the performance of elective one-stage surgery.
The rate of technical success was 93% (95% CI, 81%-99%) and of initial clinical success was 95% (95% CI, 84%-99%). In 58% (95% CI, 40%-84%) of the palliation group, clinical success was maintained after 6 months. All 19 patients with operable tumors were successfully bridged to one-stage elective surgery within a median of 5 days. One perforation and one stent migration occurred. All complications could be resolved nonsurgically.
No control group was included.
In a prospective study of through-the-scope WallFlex stent placement for malignant colonic obstruction, high rates of technical and initial clinical success, and bridging to surgery were achieved. Complications could be readily managed.
自膨式金属支架（SEMSs）可缓解恶性结肠梗阻并避免急诊减压手术。使用较大直径的结肠SEMSs可能改善肠道功能并降低移位风险。
评估一种设计用于经内镜输送的新型大直径SEMS（WallFlex）治疗恶性结肠梗阻的有效性和安全性。
前瞻性临床队列研究。
两个意大利研究中心。
42例连续性恶性结肠梗阻患者，其中23例需要姑息治疗，19例作为手术过渡。
结直肠SEMS置入。
技术成功，定义为首次尝试时SEMS在狭窄部位准确展开；临床成功，即肠梗阻完全缓解且无并发症；手术过渡，指择期一期手术的实施情况。
技术成功率为93%（95%CI，81%-99%），初始临床成功率为95%（95%CI，84%-99%）。在姑息治疗组中，58%（95%CI，40%-84%）的患者在6个月后仍维持临床成功。所有19例可手术切除肿瘤的患者均在中位时间5天内成功过渡到一期择期手术。发生1例穿孔和1例支架移位。所有并发症均可通过非手术方法解决。
未设对照组。
在一项关于经内镜置入WallFlex支架治疗恶性结肠梗阻的前瞻性研究中，技术成功率、初始临床成功率及手术过渡成功率均较高。并发症易于处理。
