Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan.
Dig Endosc. 2010 Apr;22(2):83-9. doi: 10.1111/j.1443-1661.2010.00942.x.
Self-expandable metallic stents are widely used for palliation of malignant gastric outlet obstruction (GOO), but clinical outcomes of different stents have not been compared. Here, we compared outcomes in patients with a GOO receiving either an Ultraflex (UF) or a Niti-S (NS) stent.
Prospective outcomes in 53 patients receiving palliative placement of an NS stent for symptomatic GOO over a 3-year period were compared with those obtained retrospectively in 31 patients receiving a UF stent in a previous 5-year period. Main outcome measurement was between-group comparison of clinical outcome, complications, and reintervention.
Baseline characteristics between the groups were comparable. No difference in technical or clinical success rate was observed. Median procedure time for NS placement was shorter than for UF (15 vs 40 min; P < 0.0001). Complications were more frequent with NS than with UF placement, albeit without statistical significance (16% vs 25%). Although two severe complications occurred in each group, neither was stent related in the NS group. Reintervention was more frequent in the NS group (3% vs 21%; P = 0.0485). Median survival time was 53 versus 88 days for UF versus NS stents, respectively.
Although no significant difference was seen with regard to feasibility, reintervention was less frequent with UF stents than with NS stents. However, UF stents require much more procedure time, and a complicated and difficult placement procedure. These observations suggest that although NS stents placed using a through-the-scope technique may be more patient friendly than UF stents, further optimization of through-the-scope stents is still required. Further prospective comparison of NS and UF stents in GOO treatment is warranted.
自膨式金属支架广泛用于恶性胃出口梗阻（GOO）的姑息治疗，但不同支架的临床结果尚未进行比较。在这里，我们比较了接受 GOO 治疗的患者接受 Ultraflex（UF）或 Niti-S（NS）支架治疗的结果。
在 3 年期间，前瞻性地对 53 例接受 NS 支架姑息性放置治疗有症状 GOO 的患者进行了结果评估，并与之前 5 年期间接受 UF 支架治疗的 31 例患者的回顾性结果进行了比较。主要观察指标是两组之间的临床结果、并发症和再次干预的比较。
两组患者的基线特征相当。未观察到技术或临床成功率的差异。NS 放置的中位手术时间短于 UF（15 分钟与 40 分钟；P<0.0001）。尽管 NS 组的并发症发生率高于 UF 组，但差异无统计学意义（16%与 25%）。尽管两组各有两例严重并发症，但在 NS 组中均与支架无关。NS 组的再次干预更为频繁（3%与 21%；P=0.0485）。UF 支架与 NS 支架的中位生存时间分别为 53 天与 88 天。
尽管在可行性方面没有显著差异，但 UF 支架的再次干预频率低于 NS 支架。然而，UF 支架需要更多的手术时间，并且放置过程复杂且困难。这些观察结果表明，尽管使用经内镜技术放置的 NS 支架可能比 UF 支架更适合患者，但仍需要进一步优化经内镜支架。有必要在 GOO 治疗中进一步前瞻性比较 NS 和 UF 支架。
