Hori Yasuki, Naitoh Itaru, Hayashi Kazuki, Ban Tesshin, Natsume Makoto, Okumura Fumihiro, Nakazawa Takahiro, Takada Hiroki, Hirano Atsuyuki, Jinno Naruomi, Togawa Shozo, Ando Tomoaki, Kataoka Hiromi, Joh Takashi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Gastroenterology, Midori Municipal Hospital, Nagoya, Japan.
Gastrointest Endosc. 2017 Feb;85(2):340-348.e1. doi: 10.1016/j.gie.2016.07.048. Epub 2016 Jul 27.
Uncovered self-expandable metal stents (U-SEMSs) and covered self-expandable metal stents (C-SEMSs) are available for palliative therapy for malignant gastric outlet obstruction (GOO). However, clinical differences and indications between the 2 types of SEMSs have not been elucidated.
We retrospectively compared 126 patients with U-SEMS and 126 patients with C-SEMSs with regard to clinical outcome and factors predictive of clinical improvement after SEMSs placement.
No significant difference was observed between the U-SEMS and C-SEMS groups with respect to technical success, clinical success, GOO score, or time to stent dysfunction. Stent migration was significantly more frequent in patients with C-SEMSs (U-SEMSs, .79%; C-SEMSs, 8.73%; P = .005). Karnofsky performance status, chemotherapy, peritoneal dissemination, and stent expansion ≤ 30% were associated significantly with poor GOO score improvement in multivariable analyses, but stent type was not (P = .213). In subgroup analyses, insufficient (≤30%) stent expansion was an independent factor in patients with U-SEMSs (P = .041) but not C-SEMSs. In the insufficient stent expansion subgroup, C-SEMSs was associated significantly with superior clinical improvement compared with U-SEMSs (P = .01). Insufficient stent expansion was observed more frequently in patients with GI obstruction because of anastomotic sites or metastatic cancer (44.8% [13/29], P = .001).
No clinical difference, apart from stent migration, was observed between patients with U-SEMSs and C-SEMSs. GI obstruction because of an anastomotic site or metastatic cancer may be an indication for C-SEMS use to improve oral intake after SEMSs placement.
裸金属自膨式支架（U-SEMS）和覆膜金属自膨式支架（C-SEMS）均可用于恶性胃出口梗阻（GOO）的姑息治疗。然而，这两种类型的自膨式支架之间的临床差异和适应证尚未阐明。
我们回顾性比较了126例接受U-SEMS治疗的患者和126例接受C-SEMS治疗的患者的临床结局以及自膨式支架置入后临床改善的预测因素。
在技术成功率、临床成功率、GOO评分或支架功能障碍时间方面，U-SEMS组和C-SEMS组之间未观察到显著差异。C-SEMS患者的支架移位明显更频繁（U-SEMS为0.79%；C-SEMS为8.73%；P = 0.005）。在多变量分析中，卡诺夫斯基功能状态、化疗、腹膜播散和支架扩张≤30%与GOO评分改善不佳显著相关，但支架类型与GOO评分改善无关（P = 0.213）。在亚组分析中，支架扩张不足（≤30%）是U-SEMS患者的独立因素（P = 0.041），而不是C-SEMS患者的独立因素。在支架扩张不足亚组中，与U-SEMS相比，C-SEMS与更好的临床改善显著相关（P = 0.01）。因吻合口部位或转移性癌导致胃肠道梗阻的患者中，支架扩张不足更为常见（44.8%[13/29]，P = 0.001）。
除了支架移位外，U-SEMS患者和C-SEMS患者之间未观察到临床差异。因吻合口部位或转移性癌导致的胃肠道梗阻可能是使用C-SEMS以改善自膨式支架置入后经口摄入量的适应证。
