The Glasgow Prognostic Score and stricture site can predict prognosis after endoscopic duodenal stent placement for malignant gastric outlet obstruction.
The Glasgow Prognostic Score and stricture site can predict prognosis after endoscopic duodenal stent placement for malignant gastric outlet obstruction.
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DOI：
10.1038/s41598-022-13209-x
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发表时间：
2022-06-13
影响因子：
4.6
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中科院分区：
文献类型：
--
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内镜下十二指肠支架（DS）置入治疗恶性胃出口梗阻（GOO）在临床实践中迅速增加;然而，尚未确定最适合DS置入的患者候选人。回顾性评价了2010年1月至2019年10月期间在三家日本转诊中心接受DS置入的135例GOO患者。还分析了DS置入后的总生存期（OS）、技术/临床成功率、不良事件和影响DS置入后OS的预测因素。所有患者DS置入后的中位OS为81（7-901）天。技术和临床成功率分别为99.3%和83.7%。置入DS前后GOO评分系统评分显著增加（0.9 vs. 2.7，P < 0.001）。手术相关并发症发生率为6.0%。所有19例支架闭塞患者（14.1%）均成功接受了内镜下再次介入治疗。多变量分析显示DS置入后化疗（P = 0.01），D3狭窄部位（乳头远端部分）（P = 0.01），放置十二指肠支架前的格拉斯哥预后评分（GPS）为0-1（P < 0.001）是与OS延长显著相关的因素。总之，GPS为0-1和D3狭窄且对化疗耐受的患者是DS放置的合适候选者。
Endoscopic duodenal stent (DS) placement for malignant gastric outlet obstruction (GOO) is rapidly increasing in clinical practice; however, the most suitable patient candidates for DS placement have not been determined. One hundred and thirty-five patients with GOO who underwent DS placement in three Japanese referral centers between January 2010 and October 2019 were retrospectively evaluated. Overall survival (OS) after DS placement, technical/clinical success rates, adverse events, and predictive factors affecting OS after DS placement were also analyzed. The median OS after DS placement of all patients was 81 (7–901) days. Technical and clinical success rates were 99.3% and 83.7%, respectively. The GOO Scoring System score significantly increased before and after DS placement (0.9 vs. 2.7, P < 0.001). The procedure-related complication rate was 6.0%. All 19 patients (14.1%) with stent occlusion underwent endoscopic re-intervention successfully. Multivariate analyses revealed chemotherapy after DS placement (P = 0.01), stricture site in D3 (distal part of the papilla) (P = 0.01), and a Glasgow Prognostic Score (GPS) of 0–1 before duodenal stent placement (P < 0.001) were factors significantly associated with prolonged OS. In conclusion, patients with a GPS of 0–1 and D3 stricture who are tolerant of chemotherapy are suitable candidates for DS placement.
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