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

Yıl 2018, , 50 - 53, 25.09.2018

Nuretdin Suna Ufuk Barış Kuzu , Bülent Ödemiş Selçuk Dişibeyaz , Erkin Öztaş , Diğdem Özer Etik , Hakan Yıldız , Erkan Parlak

https://doi.org/10.17940/endoskopi.370659

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

Öz

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.

Anahtar Kelimeler

Gastric outlet obstruction, malignant tumor, metal stent

Kaynakça

• REFERANS 1. Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 1999;230:322-8. 2. Lopera JE, Brazzini A, Gonzales A, et al. Gastroduodenal stent placement: current status. Radiographics 2004;24:1561-73. 3. Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002;97:72-8. 4. van Heek NT, van Geenen RC, Busch OR, et al. Palliative treatment in ‘‘peri’’-pancreatic carcinoma: stenting or surgical therapy? Acta Gastroenterol Belgica. 2002;65:171-5. 5. Monson JR, Donohue JH, McIlrath DC, et al. Total gastrectomy for advanced cancer. A worth while palliative procedure. Cancer 1991;68:1863-8. 6. Ly J, O’Grady G, Mittal A, et al. A systematic review of methods topalliate malignant gastric outlet obstruction. Surg Endosc 2010;24:290-7. 7. Bozzetti F, Bonfanti G, Audisio RA, et al. Prognosis of patients after palliative surgical procedures for carcinoma of the stomach. Surg Gynecol Obstet 1987;164:151-4. 8. Nassif T, Prat F, Meduri B, et al. Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 2003;35:483-9. 9. Telford JJ, Carr-Locke DL, Baron TH, et al. Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study. Gastrointest Endosc 2004;60:916-20. 10. Graber I, Dumas R, Filoche B, et al. The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy 2007;39:784-7. 11. Kim JH, Song HY, Shin JH, et al. Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 2007;66:256-64. 12. Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointest Endosc 2007;66:355-60. 13. Piesman M, Kozarek RA, Brandabur JJ, et al. Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial. Am J Gastroenterol 2009;104:2404-11. 14. van Hooft JE, Uitdehaag MJ, Bruno MJ, et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 2009;69:1059-66. 15. van Hooft JE, van Montfoort ML, Jeurnink SM, et al. Safety and efficacy of a new non-foreshortening nitinol stent in malignant gastric outlet obstruction (DUONITI study): a prospective, multicenter study. Endoscopy 2011;43:671-5. 16. Costamagna G, Tringali A, Spicak J, et al. Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 2012;44:37-43. 17. Sasaki T, Isayama H, Maetani I, et al. Japanese multicenter estimation of WallFlex duodenal stent for unresectable malignant gastric outlet obstruction. Dig Endosc 2013;25:1-6. 18. Miyabe K, Hayashi K, Nakazawa T, et al. Safety and benefits of self-expandable metallic stents with chemotherapy for malignant gastric outlet obstruction. Dig Endosc 2015;27:572-81. 19. Kato H, Kawamoto H, Matsumoto K, et al. Outcome of self-expandable metallic stent deployment in patients with malignant gastroduodenal outlet obstruction and Niti-S and WallFlex comparison: a multicenter retrospective clinical study. J Dig Dis 2016;17:518-25. 20. Sasaki R, Sakai Y, Tsuyuguchi T, et al. Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: A prospective Japanese multicenter study. World J Gastroenterol 2016;22:3837-44. 21. Jeurnink SM, van Eijck CH, Steyerberg EW, et al. Stent versus gastrojejunostomy for the palliation ofgastric outlet obstruction: a systematic review. BMC Gastroenterol 2007;7:18. 22. Hosono S, Ohtani H, Arimoto Y, et al. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 2007;42:283-90. 23. Kim JH, Song H-Y, Shin JH. Malignant gastric outlet obstructions: treatment with self-expandable metallic stents. Gut Liver 2010;4 Suppl 1):S32. 24. Espinel J, Sanz O, Vivas S, et al. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc 2006;20:1083-7. 25. Jeurnink SM, Steyerberg EW, Hof G, et al. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol 2007;96:389-96. 26. Roy A, Kim M, Christein J, et al. Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs. Surg Endosc 2012;26:3114-9. 27. No JH, Kim SW, Lim CH, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013;78:55-62.