Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction

Autor: Imakiire Kazuyuki, Shigeki Bamba, Keiji Hanada, Masanori Asada, Nobuaki Azemoto, Yoshitaka Nakai, Yoshifumi Fujimoto, Ichiro Moriyama, Takaaki Eguchi, Shinichi Hashimoto, Hiroko Nebiki, Hideyuki Shiomi, Hirofumi Kawamoto, Hidefumi Nishikiori, Yoshinobu Okabe, Noriyuki Hoki, Hideki Kamada, Motoyuki Yoshida, Daisuke Goto, Tetsuya Koga, Takahisa Kayahara, Hironari Kato, Yasutaka Chiba, Kazuya Matsumoto, Hiroshi Takihara, Kojiro Nakase, Shiro Hayashi, Ken Hirao, Masayuki Kitano, Chisio Noguchi, Yasushi Kudo, Takeshi Ogura, Toshiharu Ueki, Masahiro Serikawa, Yoshinori Kushiyama, Kentaro Yamao, Yukitaka Yamashita, Norimitsu Uza, Tsuyoshi Sanuki, Masaya Ohana, Takao Kato
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Self Expandable Metallic Stents
Subgroup analysis
Digestive System Neoplasms
Endoscopy
Gastrointestinal
03 medical and health sciences
0302 clinical medicine
gastrointesinal endoscopy
Risk Factors
Stomach Neoplasms
medicine
Humans
In patient
Prospective Studies
cardiovascular diseases
Prospective cohort study
Covered stent
Aged
Aged
80 and over
Gastric Outlet Obstruction
business.industry
Stomach
Palliative Care
Age Factors
Gastroenterology
Stent
Patient survival
Gastric outlet obstruction
Middle Aged
equipment and supplies
medicine.disease
Prosthesis Failure
Surgery
Self Expandable Metal Stents
Pancreatic Neoplasms
Survival Rate
surgical procedures
operative
stents
030220 oncology & carcinogenesis
Female
Gallbladder Neoplasms
030211 gastroenterology & hepatology
business
Zdroj: Gut
ISSN: 1468-3288
0017-5749
DOI: 10.1136/gutjnl-2020-320775
Popis: 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%, pConclusionsDue 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: OpenAIRE
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