Khan Saad, Gilhotra Rajit, Di Jiang Caroline, Rowbotham David, Chong Andre, Majumdar Avik, White Campbell, Huelsen Alex, Brooker Jim, O'Beirne James, Schauer Cameron, Efthymiou Marios, Vaughan Rhys, Chandran Sujievvan
Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Endosc Int Open. 2022 Mar 14;10(3):E238-E245. doi: 10.1055/a-1729-0104. eCollection 2022 Mar.
Refractory variceal bleeding is associated with high mortality in patients with chronic liver disease. A fully-covered self-expanding metal stent (SEMS) has been reported to have excellent rates of technical success and initial bleeding control; however, studies to date are small and limited to Europe and Asia. Our aim was to evaluate the efficacy and safety of this SEMS for control of refractory variceal bleeding (VB). A retrospective analysis was undertaken of all patients who received the SX-ELLA Danis SEMS for management of VB at 9 tertiary centers across Australia and New Zealand. A total of 32 SEMS had been deployed in 30 patients (median age 53.3). Technical success of SEMS placement was achieved in 100 % of cases, resulting in immediate control of bleeding across 31 of 32 cases (96.9 %). Re-bleeding with SEMS in situ occurred in three of 32 cases (9.4 %). Mean SEMS in-dwelling time was 6.4 days. Delayed SEMS migration occurred in 6.3 % of cases. Interventional radiological therapy for management of varices within 6 weeks was performed in 12 of 30 patients (40 %). Death with SEMS in situ occurred in seven of 30 patients (23.3 %). Seven-day bleeding-related mortality was 16.7 %, 14-day mortality 23.3 %, and 6-week mortality 33.3 %. Three of 30 patients (10 %) received orthotopic liver transplantation following SEMS insertion, including two patients within 6 weeks. SX-Danis Ella SEMS is highly effective for immediate control of refractory VB and bridging to definitive therapy because it has excellent technical success rates, appears to be relatively easy to use, and has low rates of serious adverse events.
难治性静脉曲张出血与慢性肝病患者的高死亡率相关。据报道，全覆膜自膨式金属支架（SEMS）在技术成功率和初始出血控制方面有着出色的表现；然而，迄今为止的研究规模较小，且仅限于欧洲和亚洲。我们的目的是评估这种SEMS控制难治性静脉曲张出血（VB）的疗效和安全性。对澳大利亚和新西兰9家三级医疗中心接受SX-ELLA Danis SEMS治疗VB的所有患者进行了回顾性分析。共有32个SEMS被植入30例患者体内（中位年龄53.3岁）。SEMS放置的技术成功率为100%，32例中有31例（96.9%）出血得到立即控制。32例中有3例（9.4%）在SEMS在位时再次出血。SEMS的平均留置时间为6.4天。6.3%的病例发生了SEMS延迟迁移。30例患者中有12例（40%）在6周内接受了介入放射治疗以处理静脉曲张。30例患者中有7例（23.3%）在SEMS在位时死亡。7天出血相关死亡率为16.7%，14天死亡率为23.3%，6周死亡率为33.3%。30例患者中有3例（10%）在植入SEMS后接受了原位肝移植，其中2例在6周内接受移植。SX-Danis Ella SEMS对难治性VB的即时控制和过渡到确定性治疗非常有效，因为它具有出色的技术成功率，使用起来似乎相对容易，且严重不良事件发生率较低。
