Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Endoscopy. 2022 Dec;54(12):1139-1146. doi: 10.1055/a-1838-5642. Epub 2022 Apr 28.
Duodenal stent placement is a palliative option for management of malignant gastric outlet obstruction (GOO). In the last 20 years, management of gastrointestinal cancers has considerably changed. It is unknown if these changes have affected clinical outcome of duodenal stent placement.
Retrospective cohort study conducted in a tertiary referral center. Patients who underwent duodenal stent placement for GOO-symptoms due to a malignant stricture were included. Primary outcome was GOO-symptom free survival. Secondary outcomes included stent-related adverse event rates. Potential explanatory parameters such as period of stent placement (1998-2009 vs 2010-2019), prior treatments, peritoneal deposits, and stricture length were evaluated using multivariable Cox regression analysis.
A total of 147 patients (62 % male; median age 64 years) were included. After a median of 28 days after stent placement, 82 patients (57 %) had recurrent GOO-symptoms. GOO-symptom free survival was significantly lower in 2010-2019 (P < 0.01). Time period was the only independent predictor for reduced GOO-symptom free survival (HR 1.76, P < 0.01). Stent-related adverse event rates increased over time (1998-2009: 31 % vs 2010-2019: 37 %). Prior treatment with chemotherapy and/or radiotherapy was significantly associated with an increased risk of adverse events (OR 2.53, P = 0.02).
Clinical outcome of duodenal stent placement did not improve over time. The decreased GOO-symptom free survival and increased adverse event rate in more recent years are probably related to the chemo- and/or radiotherapy treatment provided prior to duodenal stent placement.
十二指肠支架置入术是治疗恶性胃出口梗阻（GOO）的姑息性选择。在过去的 20 年中，胃肠道癌症的治疗发生了很大的变化。目前尚不清楚这些变化是否会影响十二指肠支架置入术的临床效果。
这是一项在三级转诊中心进行的回顾性队列研究。纳入因恶性狭窄而出现 GOO 症状并接受十二指肠支架置入术的患者。主要结局是 GOO 症状无进展生存期。次要结局包括支架相关不良事件发生率。使用多变量 Cox 回归分析评估可能的解释性参数，如支架置入时间段（1998-2009 年与 2010-2019 年）、先前的治疗、腹膜沉积和狭窄长度。
共纳入 147 例患者（62%为男性；中位年龄 64 岁）。支架置入后中位 28 天，82 例（57%）患者出现复发性 GOO 症状。2010-2019 年 GOO 症状无进展生存期明显降低（P<0.01）。时间段是 GOO 症状无进展生存期的唯一独立预测因素（HR 1.76，P<0.01）。支架相关不良事件发生率随时间推移而增加（1998-2009 年：31%比 2010-2019 年：37%）。先前接受化疗和/或放疗与不良事件风险增加显著相关（OR 2.53，P=0.02）。
十二指肠支架置入术的临床效果并未随时间的推移而改善。近年来，GOO 症状无进展生存期缩短和不良事件发生率增加可能与十二指肠支架置入术之前接受的化疗和/或放疗有关。
