Choi Sung Jun, Kim Jin Hong, Choi Jeong Woo, Lim Sun Gyo, Shin Sung Jae, Lee Kee Myoung, Lee Kwang Jae
Department of Gastroenterology and Hepatology, National Medical Center, Seoul, Republic of Korea.
Scand J Gastroenterol. 2011 Jul;46(7-8):875-80. doi: 10.3109/00365521.2011.571706. Epub 2011 May 11.
In the palliative treatment of malignant dysphagia, fully covered, retrievable metal stents are not commonly used, mainly due to the high risk of migration. Therefore, we performed a prospective study to evaluate the clinical efficacy of a fully covered, retrievable self-expanding metal stent (Niti-S).
Between October 1998 and February 2009, 100 consecutive patients with malignant esophageal obstruction treated with the fully covered Niti-S stent (Niti-S, Taewoong Medical, Seoul, South Korea) were included. Data collected contained functional outcome, feasibility of endoscopic stent retrieval, recurrent dysphagia, complications, and survival.
At 4 weeks after stent placement, dysphagia significantly improved in all patients (p = 0.000). Recurrent dysphagia occurred in 19 of 100 patients treated with Niti-S stents (19%) mainly due to tumor overgrowth (7/100, 7%), stent migration (6/100, 6%), and food impaction (6/100, 6%). Endoscopic stent retrieval was successful in all the attempted 17 patients (17/100, 17%)--7 overgrowth, 6 stent migration, 2 stent degradation, and 2 severe pain. Major complications were 2 hemorrhage, 2 severe pain, and 1 tracheal compression (5/100, 5%), and minor complications were 10 retrosternal pain and 7 symptomatic gastroesophageal reflux (17/100, 17%). After a median follow-up of 142 days, 97 patients had expired. There was no stent-related mortality or 30-day mortality.
The fully covered, retrievable Niti-S stent has proved its effectiveness for palliation of malignant dysphagia and feasibility of endoscopic retrieval. We estimate its dog-bone shaped flanges at both ends and it being completely covered provide good resistance to migration and overgrowth.
在恶性吞咽困难的姑息治疗中，全覆膜可回收金属支架并不常用，主要是因为其移位风险高。因此，我们进行了一项前瞻性研究，以评估全覆膜可回收自膨式金属支架（Niti-S）的临床疗效。
1998年10月至2009年2月，连续纳入100例接受全覆膜Niti-S支架（Niti-S，韩国首尔太宇医疗公司）治疗的恶性食管梗阻患者。收集的数据包括功能结局、内镜下取出支架的可行性、复发性吞咽困难、并发症和生存率。
支架置入后4周，所有患者吞咽困难均显著改善（p = 0.000）。100例接受Niti-S支架治疗的患者中有19例（19%）出现复发性吞咽困难，主要原因是肿瘤过度生长（7/100，7%）、支架移位（6/100，6%）和食物嵌塞（6/100，6%）。17例尝试取出支架的患者均成功取出（17/100，17%）——7例因肿瘤过度生长，6例因支架移位，2例因支架降解，2例因严重疼痛。主要并发症为2例出血、2例严重疼痛和1例气管压迫（5/100，5%），次要并发症为10例胸骨后疼痛和7例有症状的胃食管反流（17/100，17%）。中位随访142天后，97例患者死亡。无支架相关死亡或30天内死亡。
全覆膜可回收Niti-S支架已证明其在缓解恶性吞咽困难方面的有效性以及内镜下取出的可行性。我们估计其两端的狗骨形凸缘以及完全覆膜可有效防止移位和肿瘤过度生长。
