Tonozuka Ryosuke, Tsuchiya Takayoshi, Mukai Shuntaro, Nagakawa Yuichi, Itoi Takao
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Clin Endosc. 2020 Sep;53(5):510-518. doi: 10.5946/ce.2020.151. Epub 2020 Sep 23.
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient's quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%-100% and 84%-100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.
胃出口梗阻（GOO）可由壶腹周围恶性肿瘤引起，常导致患者生活质量下降。最近，使用管腔贴靠式自膨胀金属支架（LAMS）的内镜超声引导下胃肠造口术（EUS-GE）已被开发出来，作为一种治疗GOO的微创且持久的内镜治疗方法。EUS-GE技术有三种类型：（1）直接技术；（2）设备辅助技术，如球囊导管、鼻胆管引流管和超薄内镜；（3）EUS引导下双气囊闭塞式胃空肠吻合术旁路。先前关于使用LAMS的EUS-GE的报告显示，技术成功率和临床成功率（无论技术和病因如何）分别为87%-100%和84%-100%。比较EUS-GE和外科胃空肠吻合术的研究表明，两者成功率、再次干预率和成本效益相似，但EUS-GE的早期不良事件发生率较低。EUS-GE与内镜下肠内支架置入术的比较显示，两者技术成功率相似，但EUS-GE的初始临床成功率更高，需要再次干预的支架失败率更低。
