Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias. Spain.
Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias. Spain..
J Gastrointestin Liver Dis. 2023 Jun 22;32(2):143-149. doi: 10.15403/jgld-4815.
In the presence of malignant dysphagia in non-surgical candidates, a self-expanding metal stent (SEMS) represents a safe and effective approach. Recently, a through-the-scope (TTS) SEMS was launched. The aim of our study was to assess the feasibility and safety of the TTS versus over-the-wire (OTW) SEMS in patients with malignant dysphagia.
This single-center retrospective cohort study included patients with malignant dysphagia undergoing esophageal TTS and OTW-SEMS from 2012 to May-2022. The primary outcomes were the technical and the clinical success of the SEMS placement. Secondary outcomes included adverse events, patency, and survival. Patients were prospectively followed until death or loss of follow-up.
A total of 98 patients were enrolled, including 34 patients in the TTS group and 64 patients in the OTW group. TTS and OTW SEMS placement were feasible in 33 (97.1%) and 64 (100%) procedures , respectively (p=0.118). Overall, 32 patients (94.1%) in the TTS group and 62 patients (96.9%) in the OTW group showed an improvement in Ogilvie score (p=0.432). Recurrent dysphagia occurred in 30 patients, 12 in TTS group and 18 in OTW group, due to migration (4 vs. 5), stent deformation (1 vs. 1), tissue ingrowth (5 vs. 5) and overgrowth (2 vs. 7). No patient died from a stent-related cause. Median survival was 123 days (IQR: 59-209) in TTS group and 113 days (IQR: 73-271) in OTW group (p=0.349).
Placement of esophageal TTS and OTW stents resulted in similar technical and clinical outcomes, stent patency and survival in patients with malignant dysphagia.
在无法进行手术的恶性吞咽困难患者中，自膨式金属支架（SEMS）是一种安全有效的方法。最近，一种经内镜（TTS）SEMS 问世。本研究旨在评估 TTS 与经导丝（OTW）SEMS 在恶性吞咽困难患者中的可行性和安全性。
这是一项单中心回顾性队列研究，纳入了 2012 年至 2022 年 5 月期间因恶性吞咽困难而行食管 TTS 和 OTW-SEMS 的患者。主要结局是 SEMS 放置的技术和临床成功率。次要结局包括不良事件、通畅性和生存率。患者前瞻性随访至死亡或失访。
共纳入 98 例患者，其中 TTS 组 34 例，OTW 组 64 例。TTS 和 OTW SEMS 放置分别在 33 例（97.1%）和 64 例（100%）操作中可行（p=0.118）。总体而言，TTS 组 32 例（94.1%）和 OTW 组 62 例（96.9%）的 Ogilvie 评分均有改善（p=0.432）。由于支架迁移（4 例比 5 例）、支架变形（1 例比 1 例）、组织向内生长（5 例比 5 例）和过度生长（2 例比 7 例），30 例患者出现复发性吞咽困难，TTS 组 12 例，OTW 组 18 例。无患者因支架相关原因死亡。TTS 组中位生存时间为 123 天（IQR：59-209），OTW 组为 113 天（IQR：73-271）（p=0.349）。
在恶性吞咽困难患者中，食管 TTS 和 OTW 支架的放置在技术和临床结局、支架通畅性和生存率方面结果相似。
