Department of Gastroenterology, Pulido Valente Hospital, Faculty of Medical Sciences, Lisbon, Portugal.
Eur J Gastroenterol Hepatol. 2012 Jul;24(7):747-55. doi: 10.1097/MEG.0b013e328353d9d3.
Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives.
This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency.
Technical and clinical success was achieved in 100 and 97.2% of the patients, respectively. A total of 71/74 patients (95.9%) continued oral intake for the rest of their lives and 58/74 patients (78.4%) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5%). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9%. Malignant stent reobstruction was observed in 7/74 patients (9.5%). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95% confidence interval=1.14-24.45; P=0.033).
Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.
无法手术的恶性胃出口梗阻（GOO）患者已采用自膨式金属支架进行治疗，以改善口服摄入。最近的研究对自膨式金属支架在长期内恢复食物摄入的能力得出了相互矛盾的结果。本研究评估了在患者整个生命过程中通过肠内支架置入术治疗 GOO 的临床效果。
这是一项多中心、回顾性研究，对 74 例因有症状的 GOO 而行肠内支架置入术的患者进行了长期随访。通过 GOO 评分系统（GOOSS）评估了患者的整个生命过程中口服摄入的改善情况，收集数据以分析技术成功率、支架通畅性、并发症、再次干预的需求、生存率以及与支架通畅性相关的预后因素。
技术和临床成功率分别为 100%和 97.2%。74 例患者中有 71 例（95.9%）全部生命过程中持续口服摄入，58 例（78.4%）直到死亡无需进一步干预。74 例患者中有 47 例（63.5%）持续摄入固体食物（GOOSS 2-3）直至死亡。与基线相比，在随访期间 GOOSS 评分有所提高（P<0.001）。中位生存时间和平均支架通畅时间分别为 8 周和 76.6 周。并发症发生率为 18.9%。7/74 例（9.5%）患者出现恶性支架再梗阻。Cox 多变量分析显示，梗阻的十二指肠位置是唯一与支架通畅性相关的独立因素（风险比=5.28；95%置信区间=1.14-24.45；P=0.033）。
对于无法切除的 GOO 患者，肠内支架置入术是安全且具有临床疗效的。95%的患者能够恢复余生的口服摄入，绝大多数患者无需进一步干预。大约三分之二的患者直至死亡前仍持续摄入固体食物。
