Kato Hironari, Tsutsumi Koichiro, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Ann Transl Med. 2017 Apr;5(8):186. doi: 10.21037/atm.2017.02.11.
Gastric outlet obstruction (GOO) is one of severe comorbidities caused by many kinds of malignant diseases and is associated with not only degradation of patients' quality of life but also mortality. Although surgical bypass is one of the main therapies for malignant GOO, it is often difficult to perform in end-stage patients. The deployment of self-expandable metallic stents (SEMSs) has recently become a viable alternative to surgical bypass for malignant GOO. This technique is less invasive and more effective, particularly in patients with poor prognoses. Many reports have referred to the feasibility, effectiveness, and safety of the placement of SEMSs for malignant GOO. According to these reports, the rates of technical and clinical success were reported to be relatively high and the rate of adverse events to be acceptable. However, precautions against severe adverse events such as massive bleeding and perforation are necessary. Several reports have described the differences in clinical results among different kinds of SEMSs. The presence of a covered design for SEMSs may affect the patency of SEMSs and the rate of stent dysfunction. Selection of the SEMS according to axial force may affect successful achievement of long patency of SEMSs and avoidance of gastroduodenal perforation at the bending site of the duodenum. Compared with high technical success rates nearing 100%, clinical success rates were usually lower than technical success. Therefore, determination of predictive factors for failure of clinical success is important. Several papers reported that low performance status could be associated with failure of clinical success. However, the association of clinical success with other factors such as carcinomatosa and ascites remains controversial, which is a problem to be solved. Reintervention with SEMS using the stent-in-stent method after stent dysfunction can be performed effectively as well as placement of the first SEMS.
胃出口梗阻（GOO）是由多种恶性疾病引起的严重合并症之一，不仅与患者生活质量下降有关，还与死亡率相关。尽管手术旁路是恶性GOO的主要治疗方法之一，但在终末期患者中往往难以实施。近年来，自膨式金属支架（SEMS）的应用已成为恶性GOO手术旁路的一种可行替代方案。该技术侵入性较小且更有效，尤其适用于预后较差的患者。许多报告都提到了SEMS置入治疗恶性GOO的可行性、有效性和安全性。根据这些报告，技术成功率和临床成功率据报道相对较高，不良事件发生率也可接受。然而，必须预防严重不良事件，如大出血和穿孔。几份报告描述了不同类型SEMS临床结果的差异。SEMS的覆膜设计可能会影响SEMS的通畅性和支架功能障碍的发生率。根据轴向力选择SEMS可能会影响SEMS长期通畅的成功实现以及避免十二指肠弯曲部位的胃十二指肠穿孔。与接近100%的高技术成功率相比，临床成功率通常低于技术成功率。因此，确定临床成功失败的预测因素很重要。几篇论文报道低体能状态可能与临床成功失败有关。然而，临床成功与其他因素如癌性腹膜炎和腹水的关联仍存在争议，这是一个有待解决的问题。支架功能障碍后使用支架内支架方法对SEMS进行再次干预与首次置入SEMS一样有效。
