Inokuma Akiyuki, Takahara Naminatsu, Ishibashi Rei, Hakuta Ryunosuke, Ishigaki Kazunaga, Saito Kei, Saito Tomotaka, Hamada Tsuyoshi, Mizuno Suguru, Yagioka Hiroshi, Takahashi Sho, Kogure Hirofumi, Sasaki Takashi, Hirano Kenji, Ito Yukiko, Isayama Hiroyuki, Nakai Yousuke, Koike Kazuhiko, Fujishiro Mitsuhiro
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Dig Endosc. 2023 Jan;35(1):111-121. doi: 10.1111/den.14418. Epub 2022 Sep 12.
Covered self-expandable metal stent (cSEMS) for gastric outlet obstruction (GOO) has been developed to overcome tumor ingrowth but is prone to be associated with an increased risk of migration. Clinical impact of the novel large-bore cSEMS for malignant GOO remains unclear.
A total of 117 patients undergoing endoscopic cSEMS placement for malignant GOO were enrolled in this multicenter retrospective study. Technical and clinical success, adverse events, recurrent GOO, and survival after stent placement were compared between 24 mm-cSEMS (n = 49) and 20 mm-cSEMS (n = 68).
Patient characteristics were well-balanced and thus similar survival was observed between the two groups (136 days vs. 89 days, P = 0.60). Technical success rate of 100% and clinical success rate of 96% were achieved both in 24 mm-cSEMS and 20 mm-cSEMS, respectively. The median cumulative time to recurrent GOO was significantly longer in 24 mm-cSEMS than in 20 mm-cSEMS (380 days vs. 138 days, P = 0.01). The incidence of adverse events and recurrent GOO was comparable: 12% vs. 15% (P = 0.91), and 16% vs. 31% (P = 0.11); however, no stent migration was observed in 24 mm-cSEMS. In a subgroup analysis, the superiority of 24 mm-cSEMS to 20 mm-cSEMS was demonstrated in extrinsic cancers (380 days vs. 121 days, P = 0.01) but not in intrinsic cancers (151 days vs. not reached, P = 0.47).
The 24 mm-cSEMS may improve time to recurrent GOO with ensuring acceptable safety in patients with malignant GOO.
覆膜自膨式金属支架（cSEMS）已被研发用于治疗胃出口梗阻（GOO）以克服肿瘤向内生长，但它容易出现移位风险增加的问题。新型大口径cSEMS对恶性GOO的临床影响仍不明确。
本多中心回顾性研究纳入了117例行内镜下cSEMS置入术治疗恶性GOO的患者。比较了24毫米cSEMS组（n = 49）和20毫米cSEMS组（n = 68）在技术和临床成功率、不良事件、复发性GOO及支架置入后的生存率。
患者特征均衡，两组生存率相似（136天对89天，P = 0.60）。24毫米cSEMS和20毫米cSEMS的技术成功率均为100%，临床成功率分别为96%。24毫米cSEMS复发性GOO的中位累积时间显著长于20毫米cSEMS（380天对138天，P = 0.01）。不良事件和复发性GOO的发生率相当：分别为12%对15%（P = 0.91）和16%对31%（P = 0.11）；然而，24毫米cSEMS未观察到支架移位。在亚组分析中，24毫米cSEMS在外部癌症中显示出优于20毫米cSEMS（380天对121天，P = 0.01），但在内部癌症中未显示出优势（151天对未达到，P = 0.47）。
24毫米cSEMS可能会改善恶性GOO患者复发性GOO的时间，并确保可接受的安全性。
