Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
Scand J Gastroenterol. 2022 Mar;57(3):364-370. doi: 10.1080/00365521.2021.2009023. Epub 2021 Nov 28.
Endoscopic stent placement is a palliative therapy for malignant digestive tract obstruction. However, its use for malignant afferent loop obstruction (mALO) has not been adequately investigated.
From March 2009 to December 2020, 137 patients with mALO who underwent endoscopic stent placement at three tertiary care centers were retrospectively enrolled. The primary aim of this study was to compare stent dysfunction (SD) between the covered self-expandable metal stent (CSEMS) and uncovered self-expandable metal stent (UCSEMS) groups, with subgroup analysis among patients with extrinsic and intrinsic tumors separately.
Twenty-three patients developed SD in the CSEMS group and 29 patients in the UCSEMS group (log-rank = .974). The primary contributors to SD included a higher risk of stent migration in the CSEMS group and stent ingrowth in the UCSEMS group ( = .003; < .001). Among patients with extrinsic tumors, the CSEMS group showed a significantly higher probability of overall SD ( = .008) and stent migration ( = .001) with a shorter time to SD (log-rank = .006) than the UCSEMS group. Among patients with intrinsic tumors, the CSEMS group showed a significantly lower incidence of overall SD ( < .001) and stent ingrowth ( < .001) with a longer time to SD (log-rank = .011) than the UCSEMS group.
Our results showed no significant difference in SD between the CSEMS and UCSEMS groups for palliation of mALO. Furthermore, subgroup analysis suggested using CSEMSs for patients with intrinsic tumors, and UCSEMSs for those with extrinsic tumors.
内镜下支架置入术是治疗恶性消化道梗阻的姑息疗法。然而，其用于恶性输入袢梗阻（mALO）的应用尚未得到充分研究。
本回顾性研究纳入了 2009 年 3 月至 2020 年 12 月期间在三家三级护理中心接受内镜下支架置入术的 137 例 mALO 患者。本研究的主要目的是比较覆膜自膨式金属支架（CSEMS）和 uncovered 自膨式金属支架（UCSEMS）组之间的支架功能障碍（SD），并分别对外生型和内生型肿瘤患者进行亚组分析。
CSEMS 组 23 例患者发生 SD，UCSEMS 组 29 例患者发生 SD（log-rank = .974）。SD 的主要原因包括 CSEMS 组支架迁移风险较高和 UCSEMS 组支架内生长（ = .003； < .001）。在外生型肿瘤患者中，CSEMS 组总体 SD 发生率（ = .008）和支架迁移发生率（ = .001）较高，SD 发生时间较短（log-rank = .006），而 UCSEMS 组则较低。在内生型肿瘤患者中，CSEMS 组总体 SD 发生率（ < .001）和支架内生长发生率（ < .001）较低，SD 发生时间较长（log-rank = .011）。
本研究结果显示，CSEMS 和 UCSEMS 组用于 mALO 姑息治疗的 SD 发生率无显著差异。此外，亚组分析表明，对于内生型肿瘤患者，建议使用 CSEMS；对于外生型肿瘤患者，建议使用 UCSEMS。
