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自膨式金属支架治疗结直肠及结直肠外恶性肿瘤:欧洲胃肠道内镜学会(ESGE)指南-2020 年更新

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020.

机构信息

Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands.

Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands.

出版信息

Endoscopy. 2020 May;52(5):389-407. doi: 10.1055/a-1140-3017. Epub 2020 Apr 7.


DOI:10.1055/a-1140-3017
PMID:32259849
Abstract

The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 : ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 : ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 : ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 : ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 : ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 : ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 : ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.

摘要

以下建议仅应在彻底的诊断评估后应用,包括增强对比的计算机断层扫描(CT)扫描。1:ESGE 建议将结肠支架置入保留用于有临床症状和恶性大肠梗阻放射学征象但无穿孔征象的患者。ESGE 不建议预防性支架置入。强烈推荐,低质量证据。2:ESGE 建议在有潜在可治愈的左侧梗阻性结肠癌患者中,作为紧急切除的替代方案,经共同决策过程讨论将支架置入作为桥接手术的治疗选择。强烈推荐,高质量证据。3:ESGE 建议将结肠支架置入作为恶性结肠梗阻缓解的首选治疗方法。强烈推荐,高质量证据。4:ESGE 建议考虑将结肠支架置入用于近端结肠的恶性梗阻,无论是作为桥接手术还是姑息治疗。弱推荐,低质量证据。5:ESGE 建议在可治愈的左侧结肠癌患者中,将结肠支架置入作为择期手术的桥接治疗时,大约 2 周后进行切除。弱推荐,低质量证据。6:ESGE 建议应由能够熟练进行结肠镜和透视技术并且定期进行结肠支架置入的操作者进行或直接监督结肠支架置入。强烈推荐,低质量证据。7:ESGE 建议如果患者不适合结肠支架置入或支架置入专业知识不可用,则减压造口作为桥接手术是一种有效的选择。弱推荐,低质量证据。

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[3]
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[4]
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[6]
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[7]
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