Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan; Division of Gastroenterology, Yokohama City University School of Medicine, Yokohama, Japan.
Dig Endosc. 2015 Jan;27(1):121-9. doi: 10.1111/den.12300. Epub 2014 Apr 22.
Self-expandable metallic stents have mainly been used for the palliation of malignant gastric outlet obstruction (GOO). However, their use in long-term survivors and the feasibility, safety and benefit of additional intervention for stent dysfunction remain controversial. The present study examined the long-term benefits of endoscopic gastroduodenal stenting.
We reviewed 61 patients treated with Niti-S stents at several hospitals and estimated the efficacy of stent intervention, stent patency, eating period and factors related to poor effectiveness.
All 61 first stent interventions and 14 additional stent interventions (11 second interventions and 3 third interventions) were successfully carried out. Clinical success rates were 83.6% and 85.7%, and median stent patency was 214 days and 146 days (P = 0.47), respectively. Fifty patients could be treated with a first stent only, and 11 patients received additional stents. At the time of study termination or death, 70.0% of the former group and 63.6% of the latter group maintained oral intake (P = 0.71), and each 86% and 100% among the group could maintain oral intake for a period exceeding half of their remaining lives after first stent intervention. Karnofsky performance status ≤50 (P = 0.03), ascites (P = 0.009), and peritoneal dissemination (P = 0.001) appeared to be factors related to poor effectiveness.
Despite the presence of factors related to poor effectiveness, endoscopic gastroduodenal stenting would be the first treatment of choice for GOO and provide long-term benefits. If stent dysfunction occurs, additional stent intervention enables continued oral intake safely.
自膨式金属支架主要用于恶性胃出口梗阻（GOO）的姑息治疗。然而，它们在长期生存者中的应用以及支架功能障碍的额外介入的可行性、安全性和益处仍存在争议。本研究探讨了内镜胃十二指肠支架置入的长期获益。
我们回顾了在几家医院接受 Niti-S 支架治疗的 61 例患者，并评估了支架干预的疗效、支架通畅性、进食期以及与疗效不佳相关的因素。
所有 61 例初次支架干预和 14 例追加支架干预（11 例再次干预和 3 例第三次干预）均成功实施。临床成功率分别为 83.6%和 85.7%，中位支架通畅时间分别为 214 天和 146 天（P=0.47）。50 例患者仅接受初次支架治疗，11 例患者接受追加支架治疗。在研究结束或死亡时，前者组 70.0%和后者组 63.6%的患者仍能经口进食（P=0.71），初次支架干预后，每组中有 86%和 100%的患者能够经口进食的时间超过其剩余寿命的一半。Karnofsky 表现状态≤50（P=0.03）、腹水（P=0.009）和腹膜扩散（P=0.001）似乎是与疗效不佳相关的因素。
尽管存在与疗效不佳相关的因素，但内镜胃十二指肠支架置入术仍是 GOO 的首选治疗方法，并可提供长期获益。如果支架功能障碍发生，追加支架干预可安全地维持经口进食。
