Ultrathin endoscope- assisted self- expandable metallic stent placement following initial unsuccessful attempt in malignant upper gastrointestinal obstruction

作者：Park Se Woo; Lee Hyuk^*; Park Jun Chul; Shin Sung Kwan; Lee Sang Kil; Lee Yong Chan

来源：Digestive Endoscopy, 2014, 26(2): 200-207.

DOI：10.1111/den.12133

• malignant gastrointestinal obstruction
• self-expandable metallic stent (SEMS)
• ultrathin endoscopy

BackgroundConventional endoscopy for self-expandable metallic stent (SEMS) placement may be technically limited in long and tortuous strictures. Therefore, we analyzed the feasibility, safety and usefulness of ultrathin endoscopy (UTE)-guided SEMS placement.
Patients and MethodsThis study involved 24 patients with upper gastrointestinal obstruction and unsuccessful initial attempts to place SEMS using conventional endoscopy. After completely passing a UTE across the stricture, the UTE was withdrawn, leaving a guidewire placed via the working channel. Through-the-scope SEMS placement was done using a conventional endoscope inserted along the guidewire. The primary endpoints were assessed by technical/clinical success and stent patency duration.
ResultsStents were successfully placed at target locations in all but one case with a long tortuous stricture, with 95.8% (23/24) technical success. One week after stent placement, mean gastricoutlet obstruction score improved significantly from baseline (1.740.62 and 0.33 +/- 0.48, respectively; P<0.001). Stent migration, restenosis, and fracture occurred in four (17.4%), six (26.1%), and one (4.3%) of 23 stents, respectively. Median stent patency duration was 79 days. Mean stent patency was significantly longer in patients who received palliative chemotherapy than in those who did not (122.9 +/- 11.0 and 38.3 +/- 4.6, respectively; P<0.001).
ConclusionsUTE guidance SEMS delivery can be a feasible and safe rescue treatment method for malignant upper gastrointestinal obstruction in cases of failed attempts to place SEMS using conventional endoscopy. Our result warrants a further study to define the efficacy of this method in difficult SEMS placement cases.

• 出版日期2014-3