Diamantopoulos Athanasios, Sabharwal Tarun, Katsanos Konstantinos, Krokidis Miltiadis, Adam Andreas
Department of Radiology, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, UK
Department of Radiology, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, UK.
Acta Radiol. 2015 Nov;56(11):1373-9. doi: 10.1177/0284185114556491. Epub 2014 Nov 19.
Application of self-expanding metal stents (SEMS) to treat patients suffering from malignant gastroduodenal outlet obstruction (GDOO) is today considered a well-recognized palliative treatment. Use of SEMS has emerged as an attractive alternative to surgical treatment of such patients.
To report the immediate and the mid-term clinical outcomes from a series of consecutive patients treated with exclusively fluoroscopic-guided insertion of SEMS.
This was a retrospective study including patients suffering from GDOO that were either ineligible for or unwilling to undergo surgery. Patients with potentially curable disease, uncorrectable coagulopathy, gastrointestinal perforation, sepsis, presence of distal small bowel obstruction, and bowel ischemia were excluded. Technical success, clinical success, and major complications were calculated. In addition, stent migration, stent re-obstruction, restenosis, and overall re-interventions due to recurrent symptoms were considered. Kaplan-Meier survival analysis was used for patient survival estimation while both bivariable and multivariable analysis were performed to identify any independent predictors of outcomes.
Fifty-one patients, (mean age, 63.73 ± 15.62 years) met the study's criteria and were included in the final analysis. Technical and clinical success were 90.19% (n = 46/51) and 91.30% (n = 42/46), respectively. Major complications rate was 3.92%. Stent migration was noted in four cases. Restenosis and re-obstruction rates were 19.57% and 10.87%, respectively. No cases of peri-procedural mortality were noted, while Kaplan-Meier estimates for 1- and 2-year survival were 16.8% and 7.2%, respectively. Clinically successful cases and patients with primary GI tumor were related with more favorable survival compared to unsuccessful and patients suffering from GDOO due to extrinsic compression by neoplastic or lymph node disease.
Exclusively fluoroscopically inserted SEMS for GDOO is safe and highly effective method for palliative treatment.
自膨式金属支架（SEMS）应用于治疗恶性胃十二指肠梗阻（GDOO）患者如今被认为是一种公认的姑息治疗方法。使用SEMS已成为此类患者手术治疗的一种有吸引力的替代方案。
报告一系列仅在透视引导下插入SEMS治疗的连续患者的近期和中期临床结果。
这是一项回顾性研究，纳入了不适合或不愿接受手术的GDOO患者。排除有潜在可治愈疾病、无法纠正的凝血障碍、胃肠道穿孔、败血症、远端小肠梗阻和肠缺血的患者。计算技术成功率、临床成功率和主要并发症发生率。此外，还考虑了支架移位、支架再梗阻、再狭窄以及因复发症状导致的总体再次干预情况。采用Kaplan-Meier生存分析评估患者生存率，同时进行双变量和多变量分析以确定结果的任何独立预测因素。
51例患者（平均年龄63.73±15.62岁）符合研究标准并纳入最终分析。技术成功率和临床成功率分别为90.19%（n = 46/51）和91.30%（n = 42/46）。主要并发症发生率为3.92%。4例出现支架移位。再狭窄率和再梗阻率分别为19.57%和10.87%。未观察到围手术期死亡病例，Kaplan-Meier估计1年和2年生存率分别为16.8%和7.2%。与未成功的病例以及因肿瘤或淋巴结疾病外在压迫导致GDOO的患者相比，临床成功的病例和原发性胃肠道肿瘤患者的生存率更优。
仅在透视下为GDOO插入SEMS是一种安全且高效的姑息治疗方法。
