Venu R P, Pastika B J, Kini M, Chua D, Christian R, Schlais J, Brown R D
Section of Digestive and Liver Diseases, University of Illinois at Chicago, 60612-7323, USA.
Endoscopy. 1998 Aug;30(6):553-8. doi: 10.1055/s-2007-1001343.
Endoscopic palliative treatment may be effective in the management of malignant gastric outlet obstruction. However, experience in this area is limited, and the techniques vary widely. In this retrospective study, a uniform technique using nearly identical self-expandable metal stents was employed to assess technical feasibility, safety, and outcome.
Eight patients presenting with clinical findings of gastric outlet obstruction confirmed by upper gastrointestinal radiography underwent endoscopic placement of expandable metal stents. All patients had primary or metastatic malignancy involving the pylorus or duodenum. Endoscopic and Gastrografin-enhanced upper gastrointestinal radiographic evaluations were carried out immediately after stent placement. Complications and clinical outcomes were assessed in each patient.
Five patients had extrinsic compression of the descending duodenum due to pancreatic cancer, two had pyloric stenosis from metastatic cancer, and one patient had primary duodenal cancer. Stent placement was successful in all patients, and was followed by clinical improvement. There was one death within 30 days, related to pneumonia.
Endoscopic self-expandable stent placement appears to be a reasonable therapeutic alternative in patients with malignant gastric outlet obstruction.
内镜姑息治疗在恶性胃出口梗阻的处理中可能有效。然而，该领域的经验有限，技术差异很大。在这项回顾性研究中，采用了一种使用几乎相同的自膨式金属支架的统一技术，以评估技术可行性、安全性和结果。
8例经上消化道造影证实有胃出口梗阻临床表现的患者接受了可膨胀金属支架的内镜置入。所有患者均有累及幽门或十二指肠的原发性或转移性恶性肿瘤。支架置入后立即进行内镜和泛影葡胺增强上消化道造影评估。对每位患者的并发症和临床结果进行评估。
5例患者因胰腺癌导致十二指肠降部外压性狭窄，2例因转移性癌导致幽门狭窄，1例为原发性十二指肠癌。所有患者支架置入均成功，随后临床症状改善。30天内有1例死亡，与肺炎有关。
内镜自膨式支架置入术似乎是恶性胃出口梗阻患者合理的治疗选择。
