Ngamruengphong Saowanee, Sharaiha Reem, Sethi Amrita, Siddiqui Ali, DiMaio Christopher J, Gonzalez Susana, Rogart Jason, Jagroop Sophia, Widmer Jessica, Im Jennifer, Hasan Raza Abbas, Laique Sobia, Gonda Tamas, Poneros John, Desai Amit, Wong Katherine, Villgran Vipin, Brewer Gutierrez Olaya, Bukhari Majidah, Chen Yen-I, Hernaez Ruben, Hanada Yuri, Sanaei Omid, Agarwal Amol, Kalloo Anthony N, Kumbhari Vivek, Singh Vikesh, Khashab Mouen A
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States.
Endosc Int Open. 2018 Feb;6(2):E217-E223. doi: 10.1055/s-0043-125363. Epub 2018 Feb 2.
Self-expandable metallic stents (SEMS) have been increasingly used in benign conditions (e. g. strictures, fistulas, leaks, and perforations). Fully covered SEMS (FSEMS) were introduced to avoid undesirable consequences of partially covered SEMS (PSEMS), but come with higher risk of stent migration. Endoscopic suturing (ES) for stent fixation has been shown to reduce migration of FSEMS. Our aim was to compare the outcomes of FSEMS with ES (FS/ES) versus PSEMS in patients with benign upper gastrointestinal conditions.
We retrospectively identified all patients who underwent stent placement for benign gastrointestinal conditions at seven US tertiary-care centers. Patients were divided into two groups: FSEMS with ES (FS/ES group) and PSEMS (PSEMS group). Clinical outcomes between the two groups were compared.
A total of 74 (FS/ES 46, PSEMS 28) patients were included. On multivariable analysis, there was no significant difference in rate of stent migration between FS/ES (43 %) and PSEMS (15 %) (adjusted odds ratio 0.56; 95 % CI 0.15 - 2.00). Clinical success was similar [68 % vs. 64 %; = 0.81]. Rate of adverse events (AEs) was higher in PSEMS group [13 (46 %) vs. 10 (21 %); = 0.03). Difficult stent removal was higher in the PSEMS group (n = 5;17 %) vs. 0 % in the FS/ES group; = 0.005.
The proportion of stent migration of FS/ES and PSEMS are similar. Rates of other stent-related AEs were higher in the PSEMS group. PSEMS was associated with tissue ingrowth or overgrowth leading to difficult stent removal, and secondary stricture formation. Thus, FSEMS with ES for stent fixation may be the preferred modality over PSEMS for the treatment of benign upper gastrointestinal conditions.
自膨式金属支架（SEMS）在良性疾病（如狭窄、瘘管、渗漏和穿孔）中的应用越来越广泛。全覆膜自膨式金属支架（FSEMS）被引入以避免部分覆膜自膨式金属支架（PSEMS）的不良后果，但支架移位风险更高。内镜缝合（ES）用于支架固定已被证明可减少FSEMS的移位。我们的目的是比较FSEMS联合ES（FS/ES）与PSEMS在良性上消化道疾病患者中的治疗效果。
我们回顾性确定了美国七家三级医疗中心所有因良性胃肠道疾病接受支架置入的患者。患者分为两组：FSEMS联合ES组（FS/ES组）和PSEMS组（PSEMS组）。比较两组的临床结局。
共纳入74例患者（FS/ES组46例，PSEMS组28例）。多变量分析显示，FS/ES组（43%）和PSEMS组（15%）的支架移位率无显著差异（校正比值比0.56；95%可信区间0.15 - 2.00）。临床成功率相似[68%对64%；P = 0.81]。PSEMS组的不良事件（AE）发生率更高[13例（46%）对10例（21%）；P = 0.03]。PSEMS组的支架取出困难发生率更高（n = 5；17%），而FS/ES组为0%；P = 0.005。
FS/ES和PSEMS的支架移位比例相似。PSEMS组其他与支架相关的AE发生率更高。PSEMS与组织向内生长或过度生长导致支架取出困难及继发性狭窄形成有关。因此，FSEMS联合ES进行支架固定可能是治疗良性上消化道疾病优于PSEMS的首选方式。
