Gastroduodenal stents are associated with more durable patency as compared to percutaneous endoscopic gastrojejunostomy in the palliation of malignant gastric outlet obstruction.

Daniel S Strand, Ju-En C Thlick, James T Patrie, Monica R Gaidhane, Michel Kahaleh, Andrew Y Wang
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引用次数: 10

Abstract

Background: Gastroduodenal outlet obstruction (GOO) is a critical complication of cancers localized within and adjacent to the upper gastrointestinal tract. Approaches to the relief of GOO include surgical bypass with gastrojejunostomy (GJ), endoluminal placement of a self-expandable metallic stent (SEMS), and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). To date no studies have compared the outcome of utilizing PEG-J with other modalities of therapy.

Objectives: To determine if there is a difference in complications or effectiveness when survival and/or device patency of PEG-J is compared to that of gastroduodenal SEMS in patients with malignant GOO.

Methods: Patients who underwent placement of either PEG-J or gastroduodenal SEMS for unresectable malignant GOO were included in a retrospective cohort study.

Results: 24 patients (12 men) with a median age of 68.5 years underwent either PEG-J (n=12) or gastroduodenal SEMS (n=12) placement. Patients undergoing SEMS placement experienced longer overall device patency and/or survival as compared to those undergoing PEG-J (median 70 versus 35 days). Complications, including the need for re-intervention, were similar among both groups. Patients who underwent PEG-J as compared to those that had SEMS placement had a hazard ratio of 3.85 (CI 1.28-11.11) for decreased overall survival.

Conclusion: In patients with malignant GOO, placement of a palliative SEMS for gastric decompression and nutrition was associated with longer aggregate device patency and survival as compared to PEG-J. Both modalities were similar with respect to complications and the need for re-intervention.

与经皮内镜胃空肠造口术相比,胃十二指肠支架在缓解恶性胃出口梗阻方面具有更持久的通畅性。
背景:胃十二指肠出口梗阻(GOO)是局限于或邻近上胃肠道的癌症的重要并发症。缓解粘粘症的方法包括手术旁路胃空肠造口术(GJ)、腔内放置自膨胀金属支架(SEMS)和经皮内镜胃造口术(PEG-J)。到目前为止,还没有研究比较使用PEG-J与其他治疗方式的结果。目的:确定恶性粘稠性粘稠患者采用PEG-J与胃十二指肠SEMS相比,其生存率和/或设备通畅度在并发症或疗效方面是否存在差异。方法:回顾性队列研究纳入了接受PEG-J或胃十二指肠SEMS治疗不可切除的恶性粘稠物的患者。结果:24例患者(12名男性)接受了PEG-J (n=12)或胃十二指肠SEMS (n=12)放置,中位年龄为68.5岁。与接受PEG-J的患者相比,接受SEMS植入的患者总体设备通畅和/或生存时间更长(中位70天对35天)。并发症,包括再次干预的需要,在两组中相似。与放置SEMS的患者相比,接受PEG-J的患者总生存率降低的风险比为3.85 (CI 1.28-11.11)。结论:在恶性粘粘症患者中,与PEG-J相比,放置姑息性SEMS进行胃减压和营养与更长的聚合装置通畅和生存相关。两种方式在并发症和再次干预的需要方面相似。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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