Takahara Naminatsu, Nakai Yousuke, Ishida Kota, Endo Go, Kurihara Kohei, Tange Shuichi, Takaoka Shinya, Tokito Yurie, Suzuki Yukari, Oyama Hiroki, Kanai Sachiko, Suzuki Tatsunori, Sato Tatsuya, Hakuta Ryunosuke, Ishigaki Kazunaga, Saito Tomotaka, Hamada Tsuyoshi, Fujishiro Mitsuhiro
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
J Clin Med. 2023 Aug 11;12(16):5241. doi: 10.3390/jcm12165241.
Endoscopic self-expandable metal stent (SEMS) placement is a current mainstay for malignant gastric outlet obstruction (GOO), but symptomatic recurrence due to initial SEMS dysfunction commonly occurs. We aimed to compare the safety and effectiveness of second SEMS for recurrent GOO (RGOO). Between April 2006 and December 2022, a total of 95 cases with malignant RGOO undergoing second endoscopic SEMS placement were enrolled. Technical and clinical success rates, RGOO, time to RGOO (TRGOO), stent patency rate, adverse events (AE), and overall survival (OS) were retrospectively compared between covered and uncovered SEMS (cSEMS/uSEMS) groups. Risk factors for TRGOO were also explored. Baseline characteristics were well balanced between cSEMS ( = 48) and uSEMS ( = 47) groups, except for the causes of the initial SEMS dysfunction. High technical and clinical success rates with a similar incidence of AE (15% vs. 17%, = 0.78) and OS (median of 101 vs. 102 days, = 0.68) were achieved in both groups. There were no statistical differences in cumulative incidence of RGOO (19% vs. 13%, = 0.58), TRGOO (median, not reached in both groups, = 0.57), and stent patency rates at 1, 2, and 3 months between the groups (60%, 47% and 26%, respectively vs. 70%, 55% and 38%, respectively). However, TRGOO tended to be longer in cSEMS in cases with RGOO due to tumor ingrowth (median, not reached vs. 111 days, = 0.19). A Cox regression analysis demonstrated that chemotherapy after second SEMS placement was significantly associated with an improved TRGOO (the hazard ratio of 0.27 [95% confidence interval, 0.08-0.93], = 0.03). Regardless of the type of SEMS, second SEMS placement was similarly safe and effective for RGOO. The type of second SEMS might be considered based on the cause of initial SEMS dysfunction.
内镜下自膨式金属支架（SEMS）置入术是目前治疗恶性胃出口梗阻（GOO）的主要手段，但因初始SEMS功能障碍导致的症状复发较为常见。我们旨在比较再次置入SEMS治疗复发性GOO（RGOO）的安全性和有效性。2006年4月至2022年12月，共纳入95例接受第二次内镜下SEMS置入术治疗的恶性RGOO患者。对覆膜SEMS（cSEMS）组和非覆膜SEMS（uSEMS）组的技术成功率、临床成功率、RGOO发生率、RGOO发生时间（TRGOO）、支架通畅率、不良事件（AE）及总生存期（OS）进行回顾性比较。还探讨了TRGOO的危险因素。除初始SEMS功能障碍的原因外，cSEMS组（n = 48）和uSEMS组（n = 47）的基线特征均衡。两组均取得了较高的技术成功率和临床成功率，AE发生率相似（15%对17%，P = 0.78），OS也相似（中位数分别为101天和102天，P = 0.68）。两组之间RGOO的累积发生率（19%对13%，P = 0.58）、TRGOO（中位数，两组均未达到，P = 0.57）以及1、2和3个月时的支架通畅率（分别为60%、47%和26%对70%、55%和38%）均无统计学差异。然而，在因肿瘤长入导致RGOO的病例中，cSEMS的TRGOO往往更长（中位数，未达到对111天，P = 0.19）。Cox回归分析表明，第二次SEMS置入术后进行化疗与TRGOO改善显著相关（风险比为0.27 [95%置信区间，0.08 - 0.93]，P = 0.03）。无论SEMS类型如何，再次置入SEMS治疗RGOO同样安全有效。可根据初始SEMS功能障碍的原因考虑第二次SEMS的类型。
