Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction

被引：32

作者：

Yamao, Kentaro ^{[1
]}

Kitano, Masayuki ^{[1
,2
]}

Chiba, Yasutaka ^{[3
]}

Ogura, Takeshi ^{[4
]}

Eguchi, Takaaki ^{[5
]}

Moriyama, Ichiro ^{[6
]}

Yamashita, Yukitaka ^{[7
]}

Kato, Hironari ^{[8
]}

Kayahara, Takahisa ^{[9
]}

Hoki, Noriyuki ^{[10
]}

Okabe, Yoshinobu ^{[11
]}

Shiomi, Hideyuki ^{[12
]}

Nakai, Yoshitaka ^{[13
]}

Kushiyama, Yoshinori ^{[14
]}

Fujimoto, Yoshifumi ^{[15
]}

Hayashi, Shiro ^{[16
]}

Bamba, Shigeki ^{[17
]}

Kudo, Yasushi ^{[18
]}

Azemoto, Nobuaki ^{[19
]}

Ueki, Toshiharu ^{[20
]}

Uza, Norimitsu ^{[21
]}

Asada, Masanori ^{[22
]}

Matsumoto, Kazuya ^{[23
]}

Nebiki, Hiroko ^{[24
]}

Takihara, Hiroshi ^{[25
]}

Noguchi, Chisio ^{[26
]}

Kamada, Hideki ^{[27
]}

Nakase, Kojiro ^{[28
]}

Goto, Daisuke ^{[29
,30
]}

Sanuki, Tsuyoshi ^{[31
]}

Koga, Tetsuya ^{[32
]}

Hashimoto, Shinichi ^{[33
]}

Nishikiori, Hidefumi ^{[34
]}

Serikawa, Masahiro ^{[35
]}

Hanada, Keiji ^{[36
]}

Hirao, Ken ^{[37
]}

Ohana, Masaya ^{[38
]}

Kazuyuki, Imakiire ^{[39
]}

Kato, Takao ^{[40
]}

Yoshida, Motoyuki ^{[41
]}

Kawamoto, Hirofumi ^{[42
]}

机构：

[1] Kindai Univ, Fac Med Hosp, Dept Gastroenterol & Hepatol, Osakasayama, Osaka, Japan

[2] Wakayama Med Univ, Dept Internal Med 2, Wakayama, Wakayama 6410012, Japan

[3] Kindai Univ Hosp, Clin Res Ctr, Osaka, Japan

[4] Osaka Med Coll, Dept Internal Med 2, Takatsuki, Osaka, Japan

[5] Osaka Saiseikai Nakatsu Hosp, Gastroenterol & Hepatol, Osaka, Japan

[6] Shimane Univ Hosp, Innovat Canc Ctr, Matsue, Shimane, Japan

[7] Japanese Red Cross Wakayama Med Ctr, Dept Gastroenterol & Hepatol, Wakayama, Japan

[8] Okayama Univ, Dept Gastroenterol & Hepatol, Okayama, Japan

[9] Kurashiki Cent Hosp, Dept Gastroenterol & Hepatol, Kurashiki, Okayama, Japan

[10] Bell Land Gen Hosp, Gastroenterol, Sakai, Osaka, Japan

[11] Kurume Univ, Dept Med, Div Gastroenterol, Kurume, Fukuoka, Japan

[12] Kobe Univ, Dept Internal Med, Div Gastroenterol, Kobe, Hyogo, Japan

[13] Kyoto Katsura Hosp, Digest Dis Ctr, Dept Gastroenterol & Hepatol, Kyoto, Japan

[14] Matsue Red Cross Hosp, Dept Gastroenterol, Matsue, Shimane, Japan

[15] JA Hiroshima Koseiren Hiroshima Gen Hosp, Dept Gastroenterol & Hepatol, Hatsukaichi, Hiroshima, Japan

[16] Toyonaka City Hosp, Dept Gastroenterol & Hepatol, Toyonaka, Osaka, Japan

[17] Shiga Univ Med Sci, Div Clin Nutr, Otsu, Shiga, Japan

[18] Kitano Hosp, Digest Dis Ctr, Tazuke Kofukai Med Res Inst, Osaka, Japan

[19] Shikoku Canc Ctr, Dept Gastroenterol, Matsuyama, Japan

[20] Fukuoka Univ Chikushi Hosp, Dept Gastroenterol, Chikushino, Japan

[21] Kyoto Univ, Dept Gastroenterol & Hepatol, Kyoto, Japan

[22] Japanese Red Cross Soc Osaka Hosp, Dept Gastroenterol & Hepatol, Osaka, Japan

[23] Tottori Univ, Div Med & Clin Sci, Yonago, Tottori, Japan

[24] Osaka City Gen Hosp, Dept Gastroenterol, Osaka, Japan

[25] Kishiwada Tokushukai Hosp, Dept Gastroenterol & Hepatol, Kishiwada, Japan

[26] Shinbeppu Hosp, Dept Gastroenterol, Beppu, Oita, Japan

[27] Kagawa Univ, Gastroenterol & Neurol, Takamatsu, Kagawa, Japan

[28] Japanese Red Cross Kyoto Daini Hosp, Dept Gastroenterol, Kyoto, Japan

[29] Tottori Municipal Hosp, Dept Gastroenterol & Hepatol, Tottori, Japan

[30] Tottori Red Cross Hosp, Dept Gastroenterol & Hepatol, Tottori, Japan

[31] Kitaharima Med Ctr, Dept Gastroenterol, Ono, Hokkaido, Japan

[32] Social Media Corp, Dept Gastroenterol, Tenyoukai Cent Hosp, Kagoshima, Japan

[33] Kagoshima Univ, Grad Sch Med & Dent Sci, Digest & Life Style Dis, Kagoshima, Kagoshima, Japan

[34] Oita Sanai Med Ctr, Dept Gastroenterol, Oita, Japan

[35] Hiroshima Univ Hosp, Dept Gastroenterol & Metab, Hiroshima, Japan

[36] Onomichi Gen Hosp, Dept Gastroenterol, Hiroshima, Japan

[37] Hiroshima City Hiroshima Citizens Hosp, Dept Internal Med, Hiroshima, Hiroshima, Japan

[38] Tenri Hosp, Dept Gastroenterol, Tenri, Nara, Japan

[39] Imakiire Gen Hosp, Dept Gastroenterol, Kagoshima, Japan

[40] Hyogo Prefectural Awaji Med Ctr, Dept Gastroenterol, Sumoto, Japan

[41] Nara Med Univ, Dept Internal Med 3, Kashihara, Nara, Japan

[42] Kawasaki Med Sch, Gen Med 2, Okayama, Japan

来源：

GUT | 2021年 / 70卷 / 07期

关键词：

GASTRODUODENAL OBSTRUCTION; GASTROJEJUNOSTOMY; MULTICENTER; OUTCOMES;

D O I：

10.1136/gutjnl-2020-320775

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objective Stenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results. Design In a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours. Results Overall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01). Conclusions Due to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.

引用

页码：1244 / +

页数：9

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