Kim Soo Hwan, Song Ho-Young, Park Jung-Hoon, Zhou Wei-Zhong, Cho Young Chul, Shin Ji Hoon, Kim Jin Hyoung
1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2 Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2017 Aug;58(8):959-963. doi: 10.1177/0284185116682379. Epub 2017 Jan 13.
Background Fluoroscopic or endoscopic placement of metallic stents is used as a safe, non-surgical, palliative treatment option for malignant gastroduodenal obstructions. However, endoscopic stent placement is not always feasible, due to the tight or tortuous stricture of the obstructed area and insufficient visualization of the stomach due to remnant food material. Purpose To assess the technical feasibility and clinical outcomes of fluoroscopic-guided stent placement in malignant gastroduodenal obstructions following the technical failure of endoscopic stent placement. Material and Methods In all, 19 patients (14 men, 5 women; age range, 36-85 years) were referred due to technical failures of tentative endoscopic stent placement. Indications were failure to pass the guide wire through the obstruction (n = 13), failure to reach the stricture lesion due to short endoscope (n = 5), and acute angulation of the stricture lesion (n = 1). Data were retrospectively collected regarding the technical and clinical success of the fluoroscopy, the dysphagia score before and after stent placement, and major complications and their management. Results Fluoroscopic stent placement was technically successful in 15/19 patients (79%). Failures were due to complete obstruction (n = 3) and acute angulation of the stricture lesion (n = 1). Clinical success was achieved in all 15 patients with successful stent placement. The dysphagia score significantly improved after stent placement ( P < 0.001). Complications occurred in 4/15 patients (27%), including tumor overgrowth (n = 2), stent collapse (n = 1), and jaundice (n = 1). Conclusion Fluoroscopic stent placement in malignant gastroduodenal obstructions following a technical failure of endoscopic stent placement is technically feasible and has an acceptable clinical outcome.
金属支架的荧光镜或内镜下放置是恶性胃十二指肠梗阻的一种安全、非手术的姑息治疗选择。然而，由于梗阻部位狭窄或迂曲，以及残留食物材料导致胃的可视化不足，内镜下支架放置并不总是可行的。目的：评估在内镜下支架放置技术失败后，荧光镜引导下支架放置治疗恶性胃十二指肠梗阻的技术可行性和临床结果。材料与方法：共有19例患者（14例男性，5例女性；年龄范围36 - 85岁）因内镜下支架放置的技术失败而转诊。适应证包括导丝无法通过梗阻部位（n = 13）、内镜过短无法到达狭窄病变部位（n = 5）以及狭窄病变急性成角（n = 1）。回顾性收集有关荧光镜检查的技术和临床成功情况、支架放置前后的吞咽困难评分以及主要并发症及其处理的数据。结果：19例患者中有15例（79%）荧光镜下支架放置技术成功。失败原因包括完全梗阻（n = 3）和狭窄病变急性成角（n = 1）。所有15例支架放置成功的患者均取得了临床成功。支架放置后吞咽困难评分显著改善（P < 0.001）。15例患者中有4例（27%）发生并发症，包括肿瘤过度生长（n = 2）、支架塌陷（n = 1）和黄疸（n = 1）。结论：在内镜下支架放置技术失败后，荧光镜引导下支架放置治疗恶性胃十二指肠梗阻在技术上是可行的，且临床结果可接受。
