Department of Gastroenterology, G.B. Pant Hospital, Room No. 210, Academic Block, J L N Marg, New Delhi, 110 002, India.
Department of Gastroenterology, Medanta-The Medicity Hospital, Gurugram, 122 001, India.
Indian J Gastroenterol. 2024 Oct;43(5):1030-1036. doi: 10.1007/s12664-024-01639-6. Epub 2024 Aug 21.
We aimed at evaluating the safety and efficacy of self-expandable metallic stent (SEMS) insertion for managing patients with benign gastric outlet obstruction (GOO).
This prospective interventional study included 23 patients. All consecutive treatment-naïve symptomatic patients with benign GOO were recruited. Fully covered SEMS were deployed across the stricture under fluoroscopic and endoscopic guidance. Technical success, clinical success and sustained treatment response (STR) were assessed. Technical success was defined as the successful deployment of SEMS at the desired anatomic location. Clinical success was defined as the resolution of symptoms and an increase in Gastric Outlet Obstruction Scoring System (GOOSS) of at least 1 point from the baseline score on Day 7. STR was assessed at four and eight weeks post stent removal in patients who had a response at week four. Factors associated with stent migration and non-response at week four were also assessed.
The median age of the study population was 30 years (range 19-65 years). Males constituted 65.22%. Most patients presented with vomiting (100%) and abdominal pain (95.65%). Peptic stricture was most common etiology for GOO (60.9%) followed by tubercular (26.1%) and corrosive (13%). Most common site of obstruction was junction of first and second part of duodenum (69.57%) followed by pyloric (30.43%). Median length of stricture was 2 cm (range 1.5-4). Technical success was achieved in all 23 patients (100%). Clinical success was achieved in 21 patients (91.3%). Response at Day 28 was seen in 20 patients (86.95%). Eighteen of 20 (90%) patients who had a response at week four had STR at week four and week eight after stent removal. Stent migration occurred in five (21.7%) patients. On univariate analysis, stricture length, calibre and stent length were found to predict migration.
Fully covered SEMS was an effective and safe management modality in patients with benign GOO. Stent migration remains a troublesome disadvantage.
本研究旨在评估自膨式金属支架（SEMS）置入治疗良性胃出口梗阻（GOO）患者的安全性和疗效。
这是一项前瞻性介入研究，共纳入 23 例患者。所有连续未经治疗的症状性良性 GOO 患者均纳入研究。在透视和内镜引导下将全覆膜 SEMS 放置于狭窄部位。评估技术成功率、临床成功率和持续治疗反应（STR）。技术成功定义为支架在预期的解剖位置成功放置。临床成功定义为症状缓解，且在第 7 天较基线评分至少增加 1 分，胃出口梗阻评分系统（GOOSS）评分升高。在第 4 周有反应的患者中，在支架取出后 4 周和 8 周评估 STR。还评估了与第 4 周支架迁移和无反应相关的因素。
研究人群的中位年龄为 30 岁（19-65 岁）。男性占 65.22%。大多数患者表现为呕吐（100%）和腹痛（95.65%）。胃食管反流病最常见的病因是消化性狭窄（60.9%），其次是结核（26.1%）和腐蚀性（13%）。最常见的梗阻部位是十二指肠第一段和第二段交界处（69.57%），其次是幽门（30.43%）。狭窄长度中位数为 2cm（1.5-4cm）。23 例患者均达到技术成功（100%）。21 例患者（91.3%）达到临床成功。28 天时有 20 例患者（86.95%）有反应。第 4 周有反应的 18 例患者（90%）在第 4 周和第 8 周支架取出后均有 STR。5 例患者（21.7%）出现支架迁移。单因素分析显示，狭窄长度、直径和支架长度是预测迁移的因素。
全覆膜 SEMS 是治疗良性 GOO 患者的有效且安全的方法。支架迁移仍然是一个麻烦的缺点。
