Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1830 E. Monument Street, Room 424, Baltimore, MD 21205, USA.
Surg Endosc. 2013 Jun;27(6):2068-75. doi: 10.1007/s00464-012-2712-7. Epub 2013 Jan 9.
Endoscopic placement of enteral self-expandable metallic stents is an alternative to surgical gastrojejunostomy (GJ) for palliation of malignant gastric outlet obstruction (GOO). Factors associated with clinical outcomes are not known. The aims of this study are to compare the overall complication rate and effectiveness (duration of oral intake) between endoscopic stenting (ES) and GJ in patients with GOO and identify predictors of clinical outcomes.
This was a retrospective cohort study at a single tertiary academic center. Patients who underwent ES or GJ for treatment of GOO between 1/2001 and 12/2010 were identified using an institutional claims database. The electronic medical records for each patient were reviewed. Univariate and multivariate logistic regression analyses were performed to study the association of treatment outcomes with patient factors and cancer therapy.
120 patients had ES while 227 had GJ. Technical success was higher for GJ (99 vs. 96 %, p = 0.004). Complication rates were higher in the GJ group (22.10 vs. 11.66 %, p = 0.02). Reintervention was more common with ES [adjusted odds ratio (OR) 9.18, p < 0.0001]. Mean length of hospital stay (LOHS) was shorter (adjusted p = 0.005) in the ES compared with the GJ group. However, mean hospital charges, including reinterventions, were greater in the ES group (US $34,250 vs. US $27,599, p = 0.03). ES and GJ had comparable reintervention-free time in patients who had reintervention (88 vs. 106 days, respectively, p = 0.79). Chemotherapy [adjusted hazard ratio (HR) 3 > 0.57, p = 0.04] and radiation therapy (adjusted HR 0.35, p = 0.03) were associated with significantly longer duration of oral intake after ES or GJ.
ES is associated with fewer complications, shorter LOHS, but higher reintervention rates and overall charges.
内镜下放置肠内自膨式金属支架是恶性胃出口梗阻（GOO）姑息治疗的一种替代手术胃空肠吻合术（GJ）的方法。目前尚不清楚与临床结局相关的因素。本研究旨在比较内镜下支架置入术（ES）和 GJ 治疗 GOO 患者的总体并发症发生率和有效性（口服摄入持续时间），并确定临床结局的预测因素。
这是一项单中心回顾性队列研究。使用机构索赔数据库，确定 2001 年 1 月至 2010 年 12 月期间因 GOO 接受 ES 或 GJ 治疗的患者。对每位患者的电子病历进行了审查。采用单变量和多变量逻辑回归分析研究治疗结果与患者因素和癌症治疗的关系。
120 例患者行 ES，227 例行 GJ。GJ 的技术成功率更高（99%比 96%，p=0.004）。GJ 组并发症发生率更高（22.10%比 11.66%，p=0.02）。ES 组再干预更常见[校正优势比（OR）9.18，p<0.0001]。ES 组的平均住院时间（LOHS）更短（校正后 p=0.005），但 ES 组的总住院费用（包括再干预）更高（34250 美元比 27599 美元，p=0.03）。对于接受再干预的患者，ES 和 GJ 的再干预免费时间相当（分别为 88 天和 106 天，p=0.79）。ES 或 GJ 后口服摄入持续时间较长与化疗[校正风险比（HR）3>0.57，p=0.04]和放疗[校正 HR 0.35，p=0.03]有关。
ES 与并发症较少、LOHS 较短相关，但再干预率和总费用较高。
