Developmental Endoscopy Lab, Harvard Medical School, Boston, MA, USA.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Surg Endosc. 2019 Oct;33(10):3404-3411. doi: 10.1007/s00464-018-06636-3. Epub 2019 Feb 6.
EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO); however, data comparing EUS-GE to enteral stent placement are limited. We aimed to compare clinical outcomes between EUS-GE and enteral stent placement in the palliation of malignant GOO.
Retrospective analysis of a prospectively collected database on patients who underwent EUS-GE or enteral stent placement for palliation of malignant GOO from 2014 to 2017 was conducted. Primary outcome was the rate of stent failure requiring repeat intervention. Secondary outcomes included technical and clinical success, time to repeat intervention, length of hospital stay, and adverse events.
A total of 100 consecutive patients (mean age 65.9 ± 11.9 years, 44.0% female) were identified, of which 78 underwent enteral stent placement, and 22 underwent EUS-GE. Rate of stent failure requiring repeat intervention was higher in the enteral stent group than the EUS-GE group (32.0% vs. 8.3%, p = 0.021). Technical success was achieved in 100% in both groups. Higher initial clinical success was attained in the EUS-GE group than the enteral stent group (95.8% vs. 76.3%, p = 0.042). Mean length of hospital stay following stent placement was similar between groups (p = 0.821). The enteral stent group trended towards increased adverse events (40.2% vs. 20.8%, p = 0.098). Kaplan-Meier analysis showed decreased stent function in the enteral stent group (p = 0.013).
Compared to enteral stent placement, EUS-GE has a higher rate of initial clinical success and lower rate of stent failure requiring repeat intervention. EUS-GE may be offered for selected patients with malignant GOO in centers with extensive experience.
超声内镜引导下胃造口术（EUS-GE）是一种治疗恶性胃出口梗阻（GOO）的新方法；然而，将 EUS-GE 与肠内支架置入术进行比较的数据有限。我们旨在比较 EUS-GE 与肠内支架置入术在恶性 GOO 姑息治疗中的临床疗效。
对 2014 年至 2017 年间接受 EUS-GE 或肠内支架置入术姑息治疗恶性 GOO 的患者进行前瞻性数据库的回顾性分析。主要结果是支架失败需要再次干预的发生率。次要结果包括技术和临床成功率、再次干预的时间、住院时间和不良事件。
共纳入 100 例连续患者（平均年龄 65.9±11.9 岁，44.0%为女性），其中 78 例行肠内支架置入术，22 例行 EUS-GE。肠内支架组支架失败需要再次干预的发生率高于 EUS-GE 组（32.0% vs. 8.3%，p=0.021）。两组技术成功率均为 100%。EUS-GE 组初始临床成功率高于肠内支架组（95.8% vs. 76.3%，p=0.042）。两组支架置入后的平均住院时间相似（p=0.821）。肠内支架组不良事件发生率较高（40.2% vs. 20.8%，p=0.098）。Kaplan-Meier 分析显示肠内支架组支架功能下降（p=0.013）。
与肠内支架置入术相比，EUS-GE 初始临床成功率更高，支架失败需要再次干预的发生率更低。在有丰富经验的中心，EUS-GE 可用于治疗某些恶性 GOO 患者。
