Okamoto Takeshi, Sasaki Takashi, Yoshio Toshiyuki, Mori Chinatsu, Mie Takafumi, Furukawa Takaaki, Yamada Yuto, Takeda Tsuyoshi, Kasuga Akiyoshi, Matsuyama Masato, Ozaka Masato, Fujisaki Junko, Sasahira Naoki
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Upper Gastrointestinal Division, Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Surg Endosc. 2023 Jan;37(1):319-328. doi: 10.1007/s00464-022-09519-w. Epub 2022 Aug 8.
Outcomes of partially covered self-expandable metal stents (SEMS) as an additional stent after recurrent duodenal obstruction (RDO) have not been elucidated. In this study, we compared outcomes of partially covered and uncovered SEMS placement after RDO in patients with malignant duodenal obstruction and explored factors affecting re-recurrent obstruction and overall survival in this population.
We conducted a retrospective study of patients undergoing SEMS placement for RDO at a cancer institute in Japan from July 2014 to June 2021. Clinical variables and outcomes of patients undergoing partially covered and uncovered SEMS placement were compared.
Sixty-one patients underwent SEMS placement after RDO, for which the COMVI stent was used in 38 cases and uncovered stents were used in 23 cases. Stent ingrowth was the most common cause of RDO (51.4%). Stent migration only occurred after partially covered stent placement (20% vs. 0%, p = 0.018). Choice of SEMS had no impact on time to re-RDO (median 2.8 vs. 4.1 months, p = 0.776) or overall survival (median 2.6 vs. 2.4 months, p = 0.703). Median overall survival was longer in patients receiving chemotherapy after second stenting (4.6 vs. 1.8 months, p < 0.001) and shorter in those with early RDO, regardless of the SEMS used. Use of the partially covered stent had no impact on survival or time to RDO.
While outcomes after partially covered SEMS placement for RDO were not significantly different from uncovered SEMS, migration remains a concern when they are used as a second stent. Chemotherapy after second stenting was associated with longer overall survival but not with longer time to re-RDO.
作为复发性十二指肠梗阻（RDO）后的附加支架，部分覆膜自膨式金属支架（SEMS）的疗效尚未阐明。在本研究中，我们比较了恶性十二指肠梗阻患者RDO后放置部分覆膜和未覆膜SEMS的疗效，并探讨了影响该人群再次复发梗阻和总生存期的因素。
我们对2014年7月至2021年6月在日本一家癌症研究所因RDO接受SEMS置入的患者进行了一项回顾性研究。比较了接受部分覆膜和未覆膜SEMS置入患者的临床变量和疗效。
61例患者在RDO后接受了SEMS置入，其中38例使用COMVI支架，23例使用未覆膜支架。支架内生是RDO最常见的原因（51.4%）。支架移位仅发生在部分覆膜支架置入后（20%对0%，p = 0.018）。SEMS的选择对再次发生RDO的时间（中位时间2.8个月对4.1个月，p = 0.776）或总生存期（中位时间2.6个月对2.4个月，p = 0.703）没有影响。第二次置入支架后接受化疗的患者中位总生存期更长（4.6个月对1.8个月，p < 0.001），而早期RDO患者的中位总生存期更短，无论使用何种SEMS。使用部分覆膜支架对生存期或RDO发生时间没有影响。
虽然RDO后放置部分覆膜SEMS的疗效与未覆膜SEMS没有显著差异，但当它们作为第二个支架使用时，移位仍然是一个问题。第二次置入支架后进行化疗与更长的总生存期相关，但与再次发生RDO的时间延长无关。
