Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan

详细信息    查看全文

• 作者：Kentaro Yamao ; MD¹ ; Masayuki Kitano ; MD ; PhD¹ ; ; Takahisa Kayahara ; MD ; PhD² ; Etsuji Ishida ; MD² ; Hiroshi Yamamoto ; MD ; PhD² ; Kosuke Minaga ; MD³ ; Yukitaka Yamashita ; MD ; PhD³ ; Jun Nakajima ; MD⁴ ; Masanori Asada ; MD ; PhD⁴ ; Yoshihiro Okabe ; MD⁴ ; Yukio Osaki ; MD ; PhD⁴ ; Yasutaka Chiba ; PhD⁵ ; Hajime Imai ; MD¹ ; Masatoshi Kudo ; MD ; PhD¹
• 关键词：CI ; confidence interval ; GJ ; gastrojejunostomy ; GOO ; gastric outlet obstruction ; GOOSS ; Gastric Outlet Obstruction Scoring System ; HR ; hazard ratio ; KPS ; Karnofsky performance status ; OR ; odds ratios
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：84
• 期：5
• 页码：757-763.e6
• 全文大小：220 K

文摘

Endoscopic gastroduodenal stenting for malignant gastric outlet obstruction recently has become more effective, but the factors that predict gastroduodenal stenting outcomes are poorly defined. This multicenter retrospective cohort study evaluated the clinical outcomes of gastroduodenal stenting in malignant gastroduodenal obstruction and identified factors predicting clinical ineffectiveness, stent dysfunction, and adverse events.

Methods

All consecutive patients with malignant gastroduodenal obstruction who underwent through-the-scope gastroduodenal stenting from 2009 to 2014 at 4 tertiary-care medical centers were identified. Clinically ineffective stenting was defined as symptom recurrence and a gastric outlet obstruction scoring system (GOOSS) score <2.

Results

Of the 278 patients (mean age ± standard deviation [SD] 71.7 ± 11.4 years), 121 (43.5%) and 87 (31.3%) had pancreatic and gastric cancer, respectively. Technical success was achieved in 277 patients (99.6%). GOOSS scores rose from 0.5 ± 0.6 to 2.6 ± 0.8. Stenting was ineffective in 32 patients (12.6%). Stent dysfunction that caused symptom recurrence during follow-up developed in 46 patients (16.6%). Adverse events occurred in 49 patients (17.7%). Three or more stenosis sites (odds ratio [OR] = 6.11; P < .01) and Karnofsky performance scores ≤50 (OR = 6.63; P < .01) predicted clinical ineffectiveness. Karnofsky performance scores ≤50 predicted stent dysfunction (hazard ratio [HR] = 3.63; P < .01). Bile duct stenosis (HR = 9.55; P = .02) and liver metastasis (HR = 9.42; P < .01) predicted stent overgrowth. Covered stent predicted stent migration (HR = 12.63; P < .01). Deployment of 2 stents predicted perforation (HR = 854.88; P < .01).

Conclusions

Through-the-scope gastroduodenal stenting tended to be ineffective in patients with poor performance status and long stenosis sites. Stent dysfunction occurred more frequently in patients with poorer performance status. Deployment of 2 stents was a risk factor for perforation. Identification of these risk variables may help yield better gastroduodenal stenting outcomes.