Schlemmer Claudius, Voigtländer Torsten, Drews Jan, Engelke Carsten, Marquardt Jens U, Heidrich Benjamin, Klein Friederike, Wedemeyer Heiner, Kirstein Martha M, von Hahn Thomas
Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
Semmelweis University, Asklepios Campus Hamburg, Hamburg, Germany.
Surg Endosc. 2024 Dec;38(12):7158-7164. doi: 10.1007/s00464-024-11262-3. Epub 2024 Sep 30.
Segmented self-expanding metal stents (SEMS) are an alternative to conventional unsegmented SEMS in the treatment of esophageal strictures. Due to their segmented design, they may adapt better to the surrounding structures making them less likely to migrate or cause trauma. We examined if there are clinically relevant differences between segmented and conventional esophageal SEMS in benign and malignant stenosis in terms of their functionality and safety.
We performed a multicenter, retrospective case-control study of segmented and conventional SEMS implantations in esophageal stenosis. Outcome parameters were adverse events such as migration, occlusion, and severe complications (i.e., bleeding and perforation).
79 segmented SEMS were identified and compared to 79 conventional SEMS implantations. Groups were similar in terms of age, gender, and etiology. We observed 13.9% severe complications (SEMS-associated clinically significant bleeding or perforation) in the conventional SEMS group compared to 3.8% in the segmented SEMS group. This difference was statistically significant (p = 0.025). Rates of migration and occlusion were similar between both groups. Likewise, there was no significant difference in terms of short-term (30 days) clinical success.
In this first controlled analysis, segmented SEMS were associated with fewer severe clinical complications compared to conventional SEMS.
分段自膨式金属支架（SEMS）是治疗食管狭窄的传统非分段SEMS的替代方案。由于其分段设计，它们可能更好地适应周围结构，从而降低迁移或造成创伤的可能性。我们研究了分段和传统食管SEMS在良性和恶性狭窄方面，在功能和安全性上是否存在临床相关差异。
我们对食管狭窄患者进行了一项多中心、回顾性病例对照研究，比较分段和传统SEMS植入情况。观察指标为不良事件，如迁移、堵塞和严重并发症（即出血和穿孔）。
共识别出79例分段SEMS植入病例，并与79例传统SEMS植入病例进行比较。两组在年龄、性别和病因方面相似。我们观察到传统SEMS组严重并发症（与SEMS相关的具有临床意义的出血或穿孔）发生率为13.9%，而分段SEMS组为3.8%。这一差异具有统计学意义（p = 0.025）。两组的迁移和堵塞发生率相似。同样，短期（30天）临床成功率也无显著差异。
在这项首次对照分析中，与传统SEMS相比，分段SEMS的严重临床并发症更少。
