Cheng Hao-Tsai, Tsou Yung-Kuan, Lin Cheng-Hui, Cheng Chi-Liang, Tang Jui-Hsiang, Lee Ching-Song, Sung Kai-Feng, Lee Mu-Hsien, Len Jau-Min, Chu Yin-Yi, Tsai Ming-Hung, Liu Nai-Jen
Department of Gastroenterology and Hepatology, Chang Gung Memotial Hospital, Linkou, Tao-Yuan, Taiwan.
Hepatogastroenterology. 2011 Nov-Dec;58(112):1998-2002. doi: 10.5754/hge10310.
BACKGROUND/AIMS: Gastric outlet obstruction (GOO) is frequently caused by tumor. Recently, endoscopic implantation of self-expanding metallic stents (SEMS) has been introduced as an improved palliative treatment for GOO. This study aims to study the effect of SEMS placement on nutrient intake in patients with GOO and correlate different SEMS positions with postoperative clinical outcomes.
Fifty six non-operable patients with GOO were enrolled. Obstruction of the duodenum (n=23) or gastric outlet (n=33) were commonly found. Either Wallstent Enteral Stents, WallFlex Enteral Duodenal or partially covered Ultraflex esophageal stents were placed under endoscopic and fluoroscopic guidance. The Gastric Outlet Obstruction Score (GOOSS) was used as the main outcome measurement.
The procedure was technically feasible in 100% of patients and gave satisfactory clinical results in 98.2% (55/56). The patients had a median survival time of 97.5 days (range 9-380). Median stent patency was 72 days with a range of 8 to 267 days. The average GOOSS, measuring oral intake, was significantly improved, regardless of obstruction site (p<0.05). We also found that the site of SEMS placement did not affect the clinical outcome.
Palliation with SEMS is a safe and effective method for restoring gastric intake in patients with malignant GOO.
背景/目的：胃出口梗阻（GOO）常由肿瘤引起。近来，自膨式金属支架（SEMS）内镜植入术已作为一种改良的GOO姑息治疗方法被引入。本研究旨在探讨SEMS置入对GOO患者营养摄入的影响，并将不同的SEMS位置与术后临床结果相关联。
纳入56例无法手术的GOO患者。常见十二指肠梗阻（n = 23）或胃出口梗阻（n = 33）。在内镜和透视引导下置入Wallstent肠内支架、WallFlex十二指肠肠内支架或部分覆盖的Ultraflex食管支架。胃出口梗阻评分（GOOSS）用作主要结局指标。
该操作在100%的患者中技术上可行，98.2%（55/56）的患者临床结果满意。患者的中位生存时间为97.5天（范围9 - 380天）。支架中位通畅时间为72天，范围为8至267天。无论梗阻部位如何，测量经口摄入量的平均GOOSS均显著改善（p<0.05）。我们还发现SEMS置入部位不影响临床结果。
SEMS姑息治疗是恢复恶性GOO患者胃摄入量的一种安全有效的方法。
