背景与研究目的内镜下胃十二指肠支架(GDS)是目前预期寿命有限的恶性胃出口梗阻(mGOO)患者的标准治疗方法。支架功能障碍(SD)和复杂的胰腺炎常发生在GDS部署后。我们调查了SD和并发胰腺炎的发生率和影响因素。患者和方法我们回顾性分析了在2017年10月至2022年7月期间因缓解mGOO症状而进行初次GDS部署的203例患者,其中包括109例十二指肠乳头内进行GDS部署的患者(子队列)。结果SDs,包括肿瘤向内生长(n=26),扭结(n=14),和迁移(n=13),68例(33.5%)。累积SD发生率为41.1%(95%置信区间,32.6-49.4%)。SD发病率增加到0.4%,0.16%,在<8、8-16和>16周时,每天为0.06%,分别。在多变量分析中,Niti-S幽门/十二指肠支架展开(亚分布风险比[sHR]0.26,P=0.01)和生存时间≥90天(sHR2.5,P=0.01)分别被确定为与SD显着相关的有利和危险因素。子队列中14例患者(12.8%)发生胰腺炎,实质直径明显高于非胰腺炎组(P<0.01),主胰管(MPD)口径明显低于非胰腺炎组(P<0.01)。在多变量分析中,MPD口径<3mm可独立预测胰腺炎(比值比6.8,P=0.03)。结论Niti-S幽门/十二指肠支架的部署,即使对于成角度的狭窄,显著降低SD的发生率。支架选择,预期寿命,在为mGOO部署GDS的决策过程中,应考虑MPD口径。
Background and study aims Endoscopic gastroduodenal stent (GDS) deployment is currently a standard treatment for malignant gastric outlet obstruction (mGOO) in patients with limited life expectancy; however, stent dysfunction (SD) and complicated pancreatitis often occur after GDS deployment. We investigated incidence and contributing factors of SD and complicated pancreatitis. Patients and methods We retrospectively reviewed 203 patients who underwent initial GDS deployment for palliation of mGOO symptoms between October 2017 and July 2022, including 109 who underwent GDS deployment across the duodenal papilla (sub-cohort). Results SDs, including tumor ingrowth (n = 26), kinking (n = 14), and migration (n = 13), occurred in 68 patients (33.5%). Cumulative SD incidence was 41.1% (95% confidence interval, 32.6-49.4%). SD incidence increased to 0.4%, 0.16%, and 0.06% per day at < 8, 8-16, and>16 weeks, respectively. On multivariate analysis, Niti-S pyloric/duodenal stent deployment (sub-distribution hazard ratio [sHR] 0.26, P = 0.01) and survival length ≥ 90 days (sHR 2.5, P = 0.01) were respectively identified as favorable and risk factors significantly associated with SD. Pancreatitis developed in 14 patients (12.8%) in the sub-cohort, which had significantly higher parenchymal diameter ( P < 0.01) and lower main pancreatic duct (MPD) caliber ( P < 0.01) than the non-pancreatitis cohort. On multivariate analysis, MPD caliber < 3 mm independently predicted pancreatitis (odds ratio 6.8, P = 0.03). Conclusions Deployment of the Niti-S pyloric/duodenal stent, with conformability even for angulated strictures, significantly reduced the incidence of SD. Stent selection, life expectancy, and MPD caliber should be taken into consideration during decision-making for GDS deployment for mGOO.