Malign mide çıkış obstrüksiyonunda endoskopik yöntemle metal stent uygulaması: Tersiyer bir merkezde beş yıllık tecrübe

Öz

Giriş ve Amaç: Malign mide çıkış obstrüksiyonu, özellikle pankreas ve mide kanserlerinde olmak üzere intraabdominal malignitelerin geç ve yaygın bir komplikasyonudur. Bu hastaların çoğu küratif cerrahi tedaviye uygun olmadıkları için palyatif tedavi yöntemlerine gereksinim duymaktadırlar. Palyatif amaçlı yapılan cerrahi yöntemlere göre daha az invaziv bir yöntem olan endoskopik yolla duodenal kendiliğinden genişleyebilen metal stent yerleştirme son yıllarda daha çok kullanılmaktadır. Bu retrospektif tek merkezli çalışmanın amacı, inoperabl malign mide çıkış obstrüksiyonu olan hastalarda endoskopik olarak uygulanan duodenal kendiliğinden genişleyebilen metal stent yönteminin güvenilirliğini ve etkinliğini saptamaktır. Gereç ve Yöntem: Endoskopi ünitemizde beş yıllık dönemde malign mide çıkış obstrüksiyonu nedeniyle duodenal kapsız kendiliğinden genişleyebilen metal stent uygulanan hastaların verileri retrospektif olarak incelendi. Dudenal kendiliğinden genişleyebilen metal stent yerleştirmenin teknik ve klinik başarısı ile komplikasyonları değerlendirildi. Bulgular: Malign mide çıkış obstrüksiyonu olan toplam 28 hastaya palyatif amaçlı endoskopik yol ile duodenal kapsız kendiliğinden genişleyebilen metal stent yerleştirildi. Hastaların tamamında teknik başarı elde edildi. Klinik başarı ise 25 (%89.3) hastada sağlandı. Hastaların ortalama Gastrik Outlet Obstrüksiyon Skorlama Sistemi skorunun, duodenal stent yerleştirmeden önce 0.536 iken duodenal stent yerleştirildikten iki hafta sonra 2.39’a yükseldiği görüldü (P=0.0001). Majör komplikasyon 2 (7.14) ve minör komplikasyon 2 (%7.14) hastada gelişti. Sonuç: Saptanan bulgular ışığında küratif cerrahi tedaviye uygun olmayan malign mide çıkış obstrüksiyonlu hastalarda endoskopik olarak uygulanan kendiliğinden genişleyebilen metal stent güvenli ve etkili bir palyatif yöntemdir.

Anahtar Kelimeler

• Mide çıkış obstrüksiyonu,malign tümör,metal stent

Endoscopic metal stent placement for malignant gastric outlet obstruction: A 5-year experience at a tertiary care centre

Abstract

Background and Aims: Malignant gastric outlet obstruction is a late and common complication of intra-abdominal malignancies, particularly primary pancreatic or gastric carcinomas. The majority of patients considered as unsuitable for curative surgical treatment require palliative treatment methods. Recently, endoscopic self-expendable metal stent placement, which is a minimally invasive method compared with surgery, has been performed more frequently than palliative surgery. The aim of this retrospective study was to evaluate the safety and efficacy of self-expendable metal stent placement in patients with inoperable malignant gastric outlet obstruction. Materials and Methods: This study analyzed the data of patients who underwent endoscopic uncovered self-expendable metal stents placement in the duodenum for treating malignant gastric outlet obstruction during a period of 5 years in our endoscopy unit. Technical and clinical success of the placement of duodenal self-expendable metal stents and the complications of the procedure were evaluated. Results: A total of 28 patients with malignant gastric outlet obstruction underwent endoscopic self-expendable metal stent placement. Technical success was achieved in all patients, while clinical success was observed in 25 patients (89%). According to the gastric outlet obstruction scoring system, the mean score of the patients was 0.536 before stent placement and improved significantly to 2.39 at the second week after stent placement (p = 0.0001). Major complications were observed in two patients (7.14%), and minor complications were observed in another two patients (7.14%). Conclusion: These findings indicate that endoscopic self-expendable metal stent placement was a safe and efficient palliative procedure for patients considered as unsuitable for curative surgical treatment of malignant gastric outlet obstruction.

Keywords

• Gastric outlet obstruction,malignant tumor,metal stent

Kaynakça

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