Pais-Cunha Inês, Castro Rui, Libânio Diogo, Pita Inês, Bastos Rui P, Silva Rui, Dinis-Ribeiro Mario, Pimentel-Nunes Pedro
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Gastroenterology, Portuguese Oncology Institute of Porto.
Eur J Gastroenterol Hepatol. 2018 Sep;30(9):1033-1040. doi: 10.1097/MEG.0000000000001178.
Endoscopic stenting proved to be a safe alternative to surgery for malignant intra-abdominal gastrointestinal obstruction. Although high technical success rates have been reported, some patients do not experience relief in symptoms.
This study aimed to analyse the factors predicting the effectiveness of stent placement in patients with gastrointestinal obstruction.
A retrospective study was carried out including 160 patients who underwent palliative stenting for intra-abdominal obstruction in a tertiary centre from December 2012 to July 2017. Technical and clinical success, stent dysfunction and adverse events were analysed.
The rate of technical success was 98%. The rate of early clinical success was 69 and 81% in upper and lower gastrointestinal obstructions, respectively (P=0.107). In the upper tract, obstruction caused by carcinomatosis was the only independent factor predicting early and late clinical failure [odds ratio (OR): 9.7, 95% confidence interval (CI): 2.5-38.4, P=0.001 and OR: 7.6, 95% CI: 1.8-31.9, P=0.006, respectively]. In the colon, Eastern Cooperative Oncology Group score of at least 3 was an independent factor for early clinical failure (OR: 29.8, 95% CI: 1.9-464.9, P=0.002) and obstruction caused by carcinomatosis was an independent factor for late clinical failure (OR: 14.4, 95% CI: 1.7-119.6, P=0.013). Perforation occurred in 4 patients (2.5%) and stent dysfunction occurred in 15% of patients (4% stent migration; 9% restenosis). Carcinomatosis was a risk factor for perforation (P=0.039) and migration was higher with shorter 6 cm stents (P=0.044).
Stents are effective and safe for palliation of intra-abdominal obstruction. Carcinomatosis predicts an unfavourable clinical outcome. Palliative stenting as an option should be weighed carefully in these patients.
对于恶性腹腔内胃肠道梗阻，内镜支架置入术已被证明是一种安全的手术替代方法。尽管已报道有较高的技术成功率，但一些患者的症状并未得到缓解。
本研究旨在分析预测胃肠道梗阻患者支架置入有效性的因素。
进行了一项回顾性研究，纳入了2012年12月至2017年7月在一家三级中心接受姑息性腹腔内梗阻支架置入术的160例患者。分析了技术和临床成功率、支架功能障碍及不良事件。
技术成功率为98%。上消化道和下消化道梗阻的早期临床成功率分别为69%和81%（P=0.107）。在上消化道，癌性腹膜炎所致梗阻是预测早期和晚期临床失败的唯一独立因素[比值比（OR）：9.7，95%置信区间（CI）：2.5 - 38.4，P=0.001；OR：7.6，95% CI：1.8 - 31.9，P=0.006]。在结肠，东部肿瘤协作组（Eastern Cooperative Oncology Group）评分至少为3分是早期临床失败的独立因素（OR：29.8，95% CI：1.9 - 464.9，P=0.002），癌性腹膜炎所致梗阻是晚期临床失败的独立因素（OR：14.4，95% CI：1.7 - 119.6，P=0.013）。4例患者（2.5%）发生穿孔，15%的患者出现支架功能障碍（4%支架移位；9%再狭窄）。癌性腹膜炎是穿孔的危险因素（P=0.039），6 cm短支架的移位发生率更高（P=0.044）。
支架对于缓解腹腔内梗阻有效且安全。癌性腹膜炎预示不良临床结局。对于这些患者，应谨慎权衡是否选择姑息性支架置入术。
