Watanabe Ko, Hikichi Takuto, Nakamura Jun, Takagi Tadayuki, Suzuki Rei, Sugimoto Mitsuru, Waragai Yuichi, Kikuchi Hitomi, Konno Naoki, Asama Hiroyuki, Takasumi Mika, Sato Yuki, Obara Katsutoshi, Ohira Hiromasa
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Endosc Int Open. 2017 Nov;5(11):E1044-E1049. doi: 10.1055/s-0043-111793. Epub 2017 Oct 26.
Fixation of an esophageal self-expandable metal stent (SEMS) with an over-the-scope-clip (OTSC) system for a benign stricture to prevent migration has been reported. However, the efficacy of SEMS fixation with an OTSC for malignant esophageal stricture remains unclear. The aim of this retrospective study was to evaluate the feasibility of SEMS fixation with an OTSC for a malignant esophageal stricture.
Twelve patients who underwent esophageal SEMS placement and fixation with an OTSC for a malignant esophageal stricture were included in this retrospective study. The primary endpoint was technical success. The secondary endpoint was clinical success, which was defined as an improvement of at least 1 grade in the dysphagia score 1 week after SEMS placement or changes in the dysphagia score from before SEMS placement to 1 week after SEMS placement.
The technical success rate was 100 %. The clinical success rate was 92.3 %. In 6 mild stricture cases in which a standard peroral endoscope could be used, no migration of the SEMS was observed. The median dysphagia score before and at 1 week after SEMS placement was 3 (range 2 - 4) and 0 (0 - 4), respectively, which indicated improvement at 1 week after SEMS placement compared with before SEMS placement ( = 0.002). There were no adverse events associated with placement of SEMS and deployment of an OTSC.
SEMS fixation with an OTSC is feasible for prevention of migration due to a malignant esophageal stricture.
已有报道使用套扎器（OTSC）系统固定食管自膨式金属支架（SEMS）治疗良性狭窄以防止支架移位。然而，OTSC固定SEMS治疗恶性食管狭窄的疗效仍不明确。本回顾性研究的目的是评估OTSC固定SEMS治疗恶性食管狭窄的可行性。
本回顾性研究纳入了12例行食管SEMS置入并使用OTSC固定治疗恶性食管狭窄的患者。主要终点为技术成功。次要终点为临床成功，定义为SEMS置入后1周吞咽困难评分至少提高1级或从SEMS置入前到置入后1周吞咽困难评分的变化。
技术成功率为100%。临床成功率为92.3%。在6例可使用标准经口内镜的轻度狭窄病例中，未观察到SEMS移位。SEMS置入前和置入后1周的吞咽困难评分中位数分别为3（范围2 - 4）和0（0 - 4），这表明与SEMS置入前相比，置入后1周吞咽困难有所改善（P = 0.002）。未发生与SEMS置入和OTSC展开相关的不良事件。
OTSC固定SEMS对于预防恶性食管狭窄导致的移位是可行的。
