Faculty of Medicine, University of Nice Sophia-Antipolis, Nice, France.
Endoscopy. 2013;45(1):35-41. doi: 10.1055/s-0032-1325769. Epub 2012 Nov 7.
Uncovered self-expanding metal stents offer effective relief for colonic obstruction. The aim of this study was to determine the effectiveness of fully covered self-expanding metal stents (FCSEMSs) in the treatment of benign colonic strictures.
All patients presenting with a symptomatic benign colonic stricture (occlusion or subocclusion) during a 6-year study period were treated with FCSEMSs. The stents were placed and removed 4 - 6 weeks later at one of 10 endoscopy centers. The efficacy of the stent (clinical and radiological signs of colonic decompression within 48 hours), technical success, stent retrieval, safety, and recurrence of symptoms were evaluated during follow-up. Univariate and multivariate analyses were performed to identify variables associated with clinical success, stent migration, and symptom recurrence.
The study included 43 patients (24 men, 19 women; mean age 67.6 ± 10.4) with occlusive (n = 18) or subocclusive symptoms (n = 25) due to anastomotic (n = 40), post-ischemic (n = 2), or post-radiation (n = 1) strictures. Insertion was successful in all patients. Clinical success was obtained in 35 patients (81 %). Migration was observed in 27 patients (63 %). The median duration of stenting was 21 days (95 %CI 17.8 - 35.4 days). Multivariate analysis showed that stents more than 20 mm wide migrated significantly less often. Recurrence of obstructive symptoms was observed in 23 patients (53 %), irrespective of migration. No predictive factors for recurrence or clinical efficacy were found.
FCSEMSs for treatment of symptomatic benign colonic strictures are safe and effective, despite a high rate of spontaneous migration.
uncovered 自膨式金属支架可为结肠梗阻提供有效缓解。本研究旨在确定全覆膜自膨式金属支架（FCSEMS）在治疗良性结肠狭窄中的疗效。
在 6 年的研究期间，所有出现症状性良性结肠狭窄（梗阻或亚梗阻）的患者均接受 FCSEMS 治疗。支架在 10 个内镜中心之一放置和取出 4-6 周后。在随访期间评估支架的疗效（48 小时内结肠减压的临床和影像学征象）、技术成功率、支架取出、安全性和症状复发。进行单变量和多变量分析，以确定与临床成功、支架迁移和症状复发相关的变量。
本研究纳入了 43 名患者（24 名男性，19 名女性；平均年龄 67.6 ± 10.4 岁），因吻合口（n = 40）、缺血后（n = 2）或放疗后（n = 1）狭窄而出现梗阻性（n = 18）或亚梗阻性症状（n = 25）。所有患者均成功插入支架。35 名患者（81%）获得临床成功。27 名患者（63%）观察到支架迁移。支架放置的中位时间为 21 天（95%CI 17.8-35.4 天）。多变量分析显示，支架宽度超过 20mm 的支架迁移明显减少。23 名患者（53%）出现梗阻症状复发，与支架迁移无关。未发现复发或临床疗效的预测因素。
尽管自发性迁移率较高，但 FCSEMS 治疗症状性良性结肠狭窄是安全有效的。
