Perez-Miranda Manuel, Tyberg Amy, Poletto Daniel, Toscano Ernesto, Gaidhane Monica, Desai Amit P, Kumta Nikhil A, Fayad Lea, Nieto Jose, Barthet Marc, Shah Raj, Brauer Brian C, Sharaiha Reem Z, Kahaleh Michel
*Gastroenterology, Valladolid Hospital, Valladolid ‡Surgery Department, Hospital Povisa, Vigo, Spain †Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY §Gastroenterology, University of Colorado, Denver, CO ∥Gastroenterology, Marseille University, Marseille, France.
J Clin Gastroenterol. 2017 Nov/Dec;51(10):896-899. doi: 10.1097/MCG.0000000000000887.
Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) with placement of a lumen-apposing metal stent is a minimally invasive and efficacious procedure for gastric outlet obstruction (GOO) patients not amenable to surgery. Laparoscopic gastrojejunostomy (Lap-GJ) has traditionally been the standard of care. No direct comparison between EUS-GJ and Lap-GJ has been described. Our aim was to compare the clinical outcomes, success rate, and adverse events (AE) of EUS-GJ with Lap-GJ.
Patients with GOO from 4 academic centers in 3 countries were included. Technical success was defined as successful creation of a gastrojejunostomy. Clinical success was defined as the ability to tolerate a diet postprocedure.
Data were collected on 54 patients. A total of 25 patients underwent EUS-GJ (male n=11, mean age 63.9 y) and 29 patients underwent Lap-GJ (male n=22, mean age 75.8 y). Technical success was achieved in 29 (100%) Lap-GJ group patients and 23 (88%) in the EUS-GJ group (P=0.11). AEs occurred in 41% (n=12) of patients in the Lap-GJ group and 12% (n=3) in the EUS-GJ group (P=0.0386). According to the Clavien-Dindo Classification, the Lap-GJ group AEs were grade I (n=4), grade II (n=5), grade III (n=2), and grade V (n=1); the EUS-GJ AEs were grade II (n=2) and grade V (n=1).
Although the EUS-GJ group contained more complex patients, efficacy was similar between the groups. AEs were significantly lower in the EUS-GJ group. EUS-GJ is a safe and efficacious, minimally invasive option for patients with GOO.
内镜超声引导下胃空肠吻合术（EUS-GJ）联合放置管腔对合金属支架是一种微创且有效的治疗方法，适用于不宜手术的胃出口梗阻（GOO）患者。传统上，腹腔镜胃空肠吻合术（Lap-GJ）一直是治疗的标准方法。目前尚无关于EUS-GJ和Lap-GJ之间的直接比较报道。我们的目的是比较EUS-GJ与Lap-GJ的临床结局、成功率和不良事件（AE）。
纳入来自3个国家4个学术中心的GOO患者。技术成功定义为成功创建胃空肠吻合术。临床成功定义为术后能够耐受饮食。
收集了54例患者的数据。共有25例患者接受了EUS-GJ（男性11例，平均年龄63.9岁），29例患者接受了Lap-GJ（男性22例，平均年龄75.8岁）。Lap-GJ组29例（100%）患者实现了技术成功，EUS-GJ组23例（88%）实现了技术成功（P=0.11）。Lap-GJ组41%（n=12）的患者发生了不良事件，EUS-GJ组12%（n=3）的患者发生了不良事件（P=0.0386）。根据Clavien-Dindo分类，Lap-GJ组的不良事件为I级（n=4）、II级（n=5）、III级（n=2）和V级（n=1）；EUS-GJ组的不良事件为II级（n=2）和V级（n=1）。
尽管EUS-GJ组包含更复杂的患者，但两组之间的疗效相似。EUS-GJ组的不良事件明显更低。EUS-GJ是GOO患者一种安全、有效且微创的选择。
