Predictors of outcomes in patients undergoing covered and uncovered self-expandable metal stent placement for malignant gastric outlet obstruction: a multicenter study

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• 作者：Yasuki Hori ; MD¹ ; Itaru Naitoh ; MD¹ ; ; Kazuki Hayashi ; MD¹ ; Tesshin Ban ; MD¹ ; Makoto Natsume ; MD¹ ; ² ; Fumihiro Okumura ; MD³ ; Takahiro Nakazawa ; MD⁴ ; Hiroki Takada ; MD⁵ ; Atsuyuki Hirano ; MD⁶ ; Naruomi Jinno ; MD⁷ ; Shozo Togawa ; MD⁸ ; Tomoaki Ando ; MD⁹ ; Hiromi Kataoka ; MD¹ ; Takashi Joh ; MD¹
• 关键词：CI ; confidence interval ; C-SEMS ; covered self-expandable metal stent ; GOO ; gastric outlet obstruction ; KPS ; Karnofsky performance status ; OR ; odds ratio ; U-SEMS ; uncovered self-expandable metal stent
• 刊名：Gastrointestinal Endoscopy
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：85
• 期：2
• 页码：340-348.e1
• 全文大小：552 K
• 卷排序：85

文摘

Uncovered self-expandable metal stents (U-SEMSs) and covered self-expandable metal stents (C-SEMSs) are available for palliative therapy for malignant gastric outlet obstruction (GOO). However, clinical differences and indications between the 2 types of SEMSs have not been elucidated.MethodsWe retrospectively compared 126 patients with U-SEMS and 126 patients with C-SEMSs with regard to clinical outcome and factors predictive of clinical improvement after SEMSs placement.ResultsNo significant difference was observed between the U-SEMS and C-SEMS groups with respect to technical success, clinical success, GOO score, or time to stent dysfunction. Stent migration was significantly more frequent in patients with C-SEMSs (U-SEMSs, .79%; C-SEMSs, 8.73%; P = .005). Karnofsky performance status, chemotherapy, peritoneal dissemination, and stent expansion ≤ 30% were associated significantly with poor GOO score improvement in multivariable analyses, but stent type was not (P = .213). In subgroup analyses, insufficient (≤30%) stent expansion was an independent factor in patients with U-SEMSs (P = .041) but not C-SEMSs. In the insufficient stent expansion subgroup, C-SEMSs was associated significantly with superior clinical improvement compared with U-SEMSs (P = .01). Insufficient stent expansion was observed more frequently in patients with GI obstruction because of anastomotic sites or metastatic cancer (44.8% [13/29], P = .001).ConclusionsNo clinical difference, apart from stent migration, was observed between patients with U-SEMSs and C-SEMSs. GI obstruction because of an anastomotic site or metastatic cancer may be an indication for C-SEMS use to improve oral intake after SEMSs placement.