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首页> 外文期刊>Endoscopy International Open >Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study
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Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study

机译：同轴腔管金属支架在难治性胃肠道狭窄治疗中的安全性和有效性：一项多中心研究

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Background and aims Benign gastrointestinal (GI) strictures are often refractory to standard endoscopic interventions. Fully covered coaxial lumen-apposing metal stents (LAMS) have emerged as a novel therapy for these strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures. Patients and methods A retrospective analysis was performed for patients who underwent LAMS placement for benign luminal strictures in three US centers between January 2014 and December 2016.?The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events. Results A total of 49 patients underwent 56 LAMS placement procedures. Previous treatment had failed in 39 patients (79.6?%), and anastomotic strictures were the indication in 77.6?% (38/49), with the most common site being gastrojejunal (34.7?% [17/49]). Technical success was achieved in all procedures and initial clinical success was achieved in 96.4?% of all procedures (54/56). Patient initial clinical success was 95.9?% (47/49). Stent migration occurred in 17.9?% of procedures, and was more likely to occur at sites in the lower GI tract ( P =?0.02). The mean stent dwell time was 100.6 days, and the mean follow-up was 169.8 days. Minor adverse events, not requiring hospitalization, occurred in 33.9?% of procedures, including subsequent stricture progression (10.7?%). In cases where LAMS were removed, mean follow-up time was 102.2 days. The re-intervention rate was 75?% at 300 days follow-up after stent removal. Of the LAMS placed at anastomotic strictures, 36.4?% required re-intervention, with approximately two-thirds of these re-interventions requiring placement of a new stent or surgery. Conclusion LAMS placement was successful for the management of refractory GI strictures, with good technical and initial clinical success rates. However, re-intervention rates after LAMS removal were high, and many strictures were not resolved by an extended period of stenting with these coaxial stents. LAMS placement offers additional therapeutic options and in selected cases might be considered a destination therapy for patients with recalcitrant benign strictures. Comment to this article: Endoscopy International Open – recently published Endoscopy 2017; 49(10): 1021-1021DOI: 10.1055/s-0043-119403
机译：背景和目的良性胃肠道狭窄通常对标准的内镜干预无效。完全覆盖同轴管腔的金属支架（LAMS）已经成为解决这些狭窄的新方法。这项研究的目的是评估LAMS对难治性胃肠道狭窄的安全性和有效性。患者和方法对2014年1月至2016年12月间在美国三个中心接受LAMS良性腔狭窄手术的患者进行了回顾性分析。主要结果是LAMS植入的技术成功和初步临床成功。次要结果是支架迁移，再次介入率和不良事件。结果总共49例患者接受了56例LAMS植入手术。先前的治疗失败了39例（79.6％），吻合口狭窄占77.6％（38/49），最常见的部位是胃空肠（34.7％[17/49]）。在所有程序中均取得了技术成功，在所有程序中均取得了96.4％的临床初始成功（54/56）。患者最初的临床成功率为95.9％（47/49）。支架移位发生在手术的17.9％中，并且更可能发生在下消化道部位（P = 0.02）。平均支架停留时间为100.6天，平均随访时间为169.8天。轻微不良事件（无需住院）发生在手术的33.9％中，包括随后的狭窄进展（10.7％）。如果切除了LAMS，平均随访时间为102.2天。支架取出后300天随访时的再次干预率为75％。放置在吻合口狭窄处的LAMS中，需要进行36.4％的再次介入治疗，其中大约三分之二的介入治疗需要放置新的支架或进行手术。结论LAMS放置成功治疗了难治性胃肠道狭窄，具有良好的技术和初始临床成功率。但是，LAMS移除后的再介入率很高，并且通过使用这些同轴支架进行长时间的支架置放并未解决许多狭窄问题。 LAMS放置提供了其他治疗选择，在某些情况下，对于顽固性良性狭窄的患者，可以将其视为目标治疗。对本文的评论：内窥镜国际公开赛–最近出版的《内窥镜检查2017》; 49（10）：1021-1021DOI：10.1055 / s-0043-119403

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