■随着姑息治疗的发展,恶性十二指肠梗阻变得越来越普遍。内镜超声引导下胃空肠造口术(EUS-GJ)的结果与外科胃空肠造口术或十二指肠支架置入术的结果相当。然而,EUS-GJ在技术上具有挑战性。十二指肠自膨式金属支架(SEMS)的放置很受欢迎;然而,障碍是常见的。十二指肠SEMS阻塞可以通过以支架中支架的方式插入第二SEMS来管理。因此,我们旨在分析十二指肠恶性梗阻患者继发十二指肠SEMS置入术的临床结局.
■我们回顾性分析了2016年1月至2021年12月因十二指肠支架功能障碍而接受二次十二指肠支架置入术的患者的数据。主要结果是支架通畅。次要结果是临床成功,与功能障碍相关的因素,患者生存,和不良事件。
■共纳入109例患者。平均年龄为64.4±11.2岁,63例(57.8%)为男性。92例患者(84.4%)患有胰胆管癌。94例(86.2%)临床成功。23例患者出现支架功能障碍,中位支架通畅时间为231天(95%置信区间[CI],169不可用)。在对支架通畅性进行多变量Cox危害分析后,东部肿瘤学合作小组的表现状况(危险比[HR],2.13;95%CI,1.20至3.81;p=0.010)和第一个支架通畅性≥6个月(HR,0.33;95%CI,0.11至0.95;p=0.050)仍然是显著的相关因素。5例患者发生不良事件(4.6%)。
■二次十二指肠支架置入术是首次十二指肠支架阻塞的可行选择。对于十二指肠阻塞支架,需要进行手术或EUS-GJ的进一步比较研究。
UNASSIGNED: Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) are comparable to those of surgical gastrojejunostomy or duodenal stenting. However, EUS-GJ is technically challenging. Duodenal self-expandable metallic stent (SEMS) placement is popular; however, obstructions are common. Duodenal SEMS obstruction can be managed with the insertion of a second SEMS in a stent-in-stent manner. Therefore, we aimed to analyze the clinical outcomes of secondary duodenal SEMS placement in patients with malignant duodenal obstruction.
UNASSIGNED: We retrospectively analyzed the data of patients who underwent secondary duodenal stent insertion for duodenal stent dysfunction between January 2016 and December 2021. The primary outcome was stent patency. The secondary outcomes were clinical success, factors associated with dysfunction, patient survival, and adverse events.
UNASSIGNED: A total of 109 patients were included. The mean age was 64.4±11.2 years, and 63 patients (57.8%) were male. Ninety-two patients (84.4%) had pancreaticobiliary cancer. Clinical success was achieved in 94 cases (86.2%). Twenty-three patients experienced stent dysfunction with 231 days of median stent patency (95% confidence interval [CI], 169 to not available). After a multivariable Cox hazard analysis of stent patency, the Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 2.13; 95% CI, 1.20 to 3.81; p=0.010) and the first stent patency ≥6 months (HR, 0.33; 95% CI, 0.11 to 0.95; p=0.050) remained significant associated factors. Adverse events occurred in five patients (4.6%).
UNASSIGNED: Secondary duodenal stent insertion is a viable option for first duodenal stent obstruction. Further comparative studies involving surgery or EUS-GJ for obstructed duodenal stents are warranted.