| Autor: |
Yamao, Kentaro, Kitano, Masayuki, Chiba, Yasutaka, Ogura, Takeshi, Eguchi, Takaaki, Moriyama, Ichiro, Yamashita, Yukitaka, Kato, Hironari, Kayahara, Takahisa, Hoki, Noriyuki, Okabe, Yoshinobu, Shiomi, Hideyuki, Nakai, Yoshitaka, Kushiyama, Yoshinori, Fujimoto, Yoshifumi, Hayashi, Shiro, Bamba, Shigeki, Kudo, Yasushi, Azemoto, Nobuaki, Ueki, Toshiharu, Uza, Norimitsu, Asada, Masanori, Matsumoto, Kazuya, Nebiki, Hiroko, Takihara, Hiroshi, Noguchi, Chisio, Kamada, Hideki, Nakase, Kojiro, Goto, Daisuke, Sanuki, Tsuyoshi, Koga, Tetsuya, Hashimoto, Shinichi, Nishikiori, Hidefumi, Serikawa, Masahiro, Hanada, Keiji, Hirao, Ken, Ohana, Masaya, Kazuyuki, Imakiire, Kato, Takao, Yoshida, Motoyuki, Kawamoto, Hirofumi |
| Zdroj: |
Gut; 2021, Vol. 70 Issue: 7 p1244-1252, 9p |
| Abstrakt: |
ObjectiveStenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results.DesignIn a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours.ResultsOverall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01).ConclusionsDue to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies. |
| Databáze: |
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