Catholic University, Rome, Italy.
Adv Ther. 2010 Oct;27(10):691-703. doi: 10.1007/s12325-010-0061-2. Epub 2010 Aug 19.
Duodenal self-expandable metal stents (SEMS) are designed for palliation and prompt relief of malignant gastric outlet obstruction (GOO). This mini-invasive endoscopic treatment is preferable to surgery due to its lower morbidity and mortality, shorter hospitalization, and earlier symptoms relief; furthermore endoscopic enteral stenting can be performed under conscious sedation, reducing the risk of general anesthesia in these already fragile patients. The stent placement technique is well established and should be performed in referral centers with adequate materials and equipment. Duodenal stents can be covered and uncovered. Nitinol stents have almost replaced other materials, being more flexible with a satisfactory axial and radial force. Common duodenal SEMS-related complications are recurrence of GOO symptoms due to stent clogging (tissue ingrowth/overgrowth and food impaction) and stent migration. These complications can be usually managed endoscopically. Perforation and bleeding are the most severe, but rare, complications. After stent placement, malignant GOO patients usually have improvement of the GOO symptoms with good resumption of fluids and solids. Choosing the most appropriate type of stent is arduous and should be done mainly in relation to the morphological aspects of the stricture. Endoscopic duodenal SEMS placement is indicated in symptomatic GOO patients suffering from unresectable malignancy or those inoperable due to advanced age or comorbidities. The absence of peritoneal carcinomatosis and multiple small bowel strictures is a key point for the clinical success of duodenal SEMS. Almost all symptomatic malignant GOO patients are candidates for the duodenal SEMS procedure; resolution of GOO, avoiding the need for a permanent naso-gastric or percutaneous endoscopic gastrostomy tube, significantly improves the patients' quality of life and dignity, even if life expectancy is short. Endoscopic duodenal SEMS insertion, after an adequate training, is a reproducible, simple, safe, and cost-effective procedure.
十二指肠自膨式金属支架（SEMS）旨在缓解恶性胃出口梗阻（GOO）的症状并迅速缓解。与手术相比，这种微创内镜治疗具有较低的发病率和死亡率、较短的住院时间和更早的症状缓解，此外，在这些已经脆弱的患者中，可以在清醒镇静下进行内镜肠内支架置入术，降低全身麻醉的风险。支架放置技术已经成熟，应该在具有足够材料和设备的转诊中心进行。十二指肠支架可以是覆盖的也可以是不覆盖的。镍钛诺支架几乎已经取代了其他材料，具有更好的柔韧性和令人满意的轴向和径向力。常见的十二指肠 SEMS 相关并发症是由于支架堵塞（组织向内生长/过度生长和食物嵌塞）和支架迁移导致 GOO 症状再次出现。这些并发症通常可以通过内镜进行处理。穿孔和出血是最严重但罕见的并发症。支架放置后，恶性 GOO 患者通常会改善 GOO 症状，并且能够很好地恢复液体和固体食物的摄入。选择最合适的支架类型是困难的，主要应与狭窄的形态学方面有关。内镜十二指肠 SEMS 放置适用于患有不可切除恶性肿瘤或因年龄较大或合并症而无法手术的有症状的 GOO 患者。不存在腹膜癌转移和多个小肠狭窄是内镜十二指肠 SEMS 成功的关键。几乎所有有症状的恶性 GOO 患者都是十二指肠 SEMS 手术的候选者；GOO 的缓解，避免了对永久性鼻胃管或经皮内镜胃造口管的需求，显著提高了患者的生活质量和尊严，即使预期寿命较短。在经过充分培训后，内镜十二指肠 SEMS 插入是一种可重复、简单、安全且具有成本效益的操作。
