Johns Hopkins Medicine, Baltimore, Maryland, USA.
Virginia Mason Medical Center, Seattle, Washington, USA.
Gastrointest Endosc. 2022 Jan;95(1):80-89. doi: 10.1016/j.gie.2021.07.023. Epub 2021 Aug 3.
Stent misdeployment (SM) has hindered the dissemination of EUS-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction (GOO) management. We aimed to provide a classification system for SM during EUS-GE and study clinical outcomes and management accordingly.
This is a retrospective study involving 16 tertiary care centers (8 in the United States, 8 in Europe) from March 2015 to December 2020. Patients who developed SM during EUS-GE for GOO were included. We propose classifying SM into 4 types. The primary outcome was rate and severity of SM (per American Society for Gastrointestinal Endoscopy lexicon), whereas secondary outcomes were clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM.
From 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 patients (9.85%). Most SMs (73.2%) occurred during the first 13 EUS-GE cases by the performing operators. SM was graded as mild (n = 28, 60.9%), moderate (n = 11, 23.9%), severe (n = 6, 13.0%), or fatal (n = 1, 2.2%), with 5 patients (10.9%) requiring surgical intervention. Type I SM was the most common (n = 29, 63.1%), followed by type II (n = 14, 30.4%), type IV (n = 2, 4.3%), and type III (n = 1, 2.2%). Type I SM was more frequently rated as mild compared with type II SM (75.9% vs 42.9%, P = .04) despite an equivalent rate of surgical repair (10.3% vs 7.1%, P = .7). Overall, 4 patients (8.7%) required an intensive care unit stay (median, 2.5 days). The median length of stay was 4 days after SM.
Although SM is not infrequent during EUS-GE, most are type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.
支架部署不当（SM）阻碍了超声内镜引导下胃肠吻合术（EUS-GE）在治疗胃出口梗阻（GOO）中的应用。本研究旨在建立 EUS-GE 中 SM 的分类系统，并对相应的临床结局和处理方法进行研究。
这是一项回顾性研究，纳入了 2015 年 3 月至 2020 年 12 月期间来自 16 家三级医疗中心（美国 8 家，欧洲 8 家）的患者。研究对象为 EUS-GE 治疗 GOO 过程中发生 SM 的患者。我们提出将 SM 分为 4 种类型。主要结局为根据美国胃肠内镜学会词汇表评估的 SM 发生率和严重程度，次要结局为根据 SM 分类类型发生支架移位的临床结局和处理方法，以及 SM 后 GOO 的挽救性处理。
在研究期间，467 例 EUS-GE 用于治疗 GOO，其中 46 例（9.85%）发生 SM。大多数 SM（73.2%）发生在操作者进行的前 13 例 EUS-GE 中。SM 分级为轻度（n=28，60.9%）、中度（n=11，23.9%）、重度（n=6，13.0%）或致命性（n=1，2.2%），5 例（10.9%）需要手术干预。I 型 SM 最常见（n=29，63.1%），其次是 II 型（n=14，30.4%）、IV 型（n=2，4.3%）和 III 型（n=1，2.2%）。与 II 型 SM 相比，I 型 SM 更常被评为轻度（75.9% vs. 42.9%，P=0.04），但手术修复率相当（10.3% vs. 7.1%，P=0.7）。总体而言，4 例（8.7%）患者需要入住重症监护病房（中位时间 2.5 天）。SM 后中位住院时间为 4 天。
尽管 EUS-GE 中 SM 并不少见，但大多数为 I 型，严重程度为轻度/中度，可通过内镜治疗，手术干预率约为 11%。
