Yang Juliana, Siddiqui Ali A, Kowalski Thomas E, Loren David E, Khalid Ammara, Soomro Ayesha, Mazhar Syed M, Rosé Julian, Isby Laura, Kahaleh Michel, Kalra Ankush, Sarkisian Alex M, Kumta Nikhil A, Nieto Jose, Sharaiha Reem Z
Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Surg Endosc. 2017 Mar;31(3):1414-1419. doi: 10.1007/s00464-016-5131-3. Epub 2016 Aug 5.
Endoscopic placement of fully covered self-expanding metal stents (FCSEMS) to treat malignant dysphagia in patients with esophageal cancer significantly improves dysphagia; however, these stents have a high migration rate.
To determine whether FCSEMS fixation using an endoscopic suturing device treated malignant dysphagia and prevented stent migration in patients with locally advanced esophageal cancer receiving neoadjuvant therapy when compared to patients with FCSEMS placement alone.
A review of patients with locally advanced esophageal cancer who underwent FCSEMS placement at 3 centers was performed. Patients were divided into two groups: Group A (n = 26) was composed of patients who underwent FCSEMS placement with suture placement, and Group B (n = 67) was composed of patients with FCSEMS placement alone.
There were no significant differences between Groups A and B in demographics, and tumor characteristics. The technical success rate for stent placement was 100 %. There was no difference between Groups A and B in the median stent diameter and stent lengths. Mean dysphagia score obtained at 1 week after stent placement had improved significantly from baseline (2.4 and 1, respectively, p < 0.001). Patients had a median follow-up of 4 months. Immediate adverse events were mild chest discomfort in 4 patients in Group A and 2 patients in Group B (p = 0.05), and significant acid reflux in 3 patient in Group A compared to 2 patients in Group B (p = 0.1). The stent migration rate was significantly lower in Group A compared to compared to Group B (7.7 vs 26.9 %, respectively, p = 0.004). There was a delayed perforation in 1 patient and 1 death due to aspiration pneumonia in Group B.
Fixation of esophageal FCSEMSs by using an endoscopic suturing device in patients receiving neoadjuvant therapy was shown to be feasible, safe, and relatively effective at preventing stent migration compared to those who had stent placed alone.
内镜下放置全覆膜自膨式金属支架（FCSEMS）治疗食管癌患者的恶性吞咽困难可显著改善吞咽困难；然而，这些支架的移位率较高。
与单纯放置FCSEMS的患者相比，确定使用内镜缝合装置固定FCSEMS治疗局部晚期食管癌接受新辅助治疗患者的恶性吞咽困难并预防支架移位。
对3个中心接受FCSEMS放置的局部晚期食管癌患者进行回顾性研究。患者分为两组：A组（n = 26）由接受FCSEMS放置并缝合的患者组成，B组（n = 67）由单纯接受FCSEMS放置的患者组成。
A组和B组在人口统计学和肿瘤特征方面无显著差异。支架置入的技术成功率为100%。A组和B组在支架直径中位数和支架长度方面无差异。支架置入后1周获得的平均吞咽困难评分较基线有显著改善（分别为2.4和1，p < 0.001）。患者的中位随访时间为4个月。即刻不良事件为A组4例患者和B组2例患者出现轻度胸痛（p = 0.05），A组3例患者出现明显反酸，B组2例患者出现明显反酸（p = 0.1）。A组的支架移位率显著低于B组（分别为7.7%和26.9%，p = 0.004）。B组有1例患者发生延迟穿孔，1例患者因吸入性肺炎死亡。
与单纯放置支架的患者相比，在接受新辅助治疗的患者中使用内镜缝合装置固定食管FCSEMS被证明是可行、安全的，并且在预防支架移位方面相对有效。
