Kouanda Abdul, Binmoeller Kenneth, Hamerski Christopher, Nett Andrew, Bernabe Jona, Watson Rabindra
Department of Medicine, Division of Gastroenterology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, 94109, USA.
Surg Endosc. 2021 Dec;35(12):7058-7067. doi: 10.1007/s00464-020-08221-z. Epub 2021 Jan 21.
Early data suggests that endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a safe and efficacious option for gastric outlet obstruction (GOO). However, there is a scarcity of data comparing outcomes with open gastrojejunostomy (OGJ).
Single-center retrospective cohort study of adult patients hospitalized with GOO who underwent EUS-GE or OGJ between January 1, 2014 and February 28, 2020. Primary outcomes were technical and clinical success.
Sixty-six patients were included of which 40 (60.0%) underwent EUS-GE and 26 (40.0%) underwent OGJ. Baseline characteristics were similar with respect to age (70.5 vs 69.7, p = 0.81), sex (42.5% vs 42.3% female, p = 0.99), median length of follow-up (98.0 vs 166.5 days, p = 0.8), prior failed intervention for GOO (22.5% vs 26.9%, p = 0.68), and the presence of altered anatomy (12.5% vs 30.8%, p = 0.07) between EUS-GE and OGJ, respectively. Technical success was achieved in 37 (92.5%) of EUS-GE and 26 (100%) of OGJ patients (p = 0.15). EUS-GE was associated with faster resumption of oral intake (1.3 vs 4.7 days, p < 0.001) and shorter length of stay (5 vs 14.5 days, p < 0.001). There were no significant differences in symptom recurrence (17.5% vs 19.2%, HR 1.85, CI 0.52-6.65, p = 0.34), reintervention (20% vs 11.5%, HR 0.82, CI 0.22-3.15, p = 0.78), death within 30 days (12.5% vs 3.8%, HR 0.80, CI 0.09-6.85, p = 0.84), or 30-day readmission (17.5% vs 24.1%, HR 1.69, CI 0.53-5.41, p = 0.37) between EUS-GE and OGJ, respectively. EUS-GE patients initiated chemotherapy sooner (17.7 vs 31.3 days, p = 0.033) and had lower overall costs as compared to OGJ ($49,387 vs $124,192, p < 0.001).
There were no significant differences in technical or clinical success, symptom recurrence, reintervention, 30-day readmission, or 30-day mortality between EUS-GE and OGJ. EUS-GE patients experienced shorter delays to resumption of oral intake and chemotherapy, had shorter lengths of stay, and reduced hospital costs. Further prospective comparative studies are warranted to verify our results.
早期数据表明，内镜超声引导下胃造口术（EUS-GE）是治疗胃出口梗阻（GOO）的一种安全有效的选择。然而，比较其与开放胃空肠吻合术（OGJ）疗效的数据较少。
对2014年1月1日至2020年2月28日期间因GOO住院并接受EUS-GE或OGJ的成年患者进行单中心回顾性队列研究。主要结局为技术成功和临床成功。
共纳入66例患者，其中40例（60.0%）接受了EUS-GE，26例（40.0%）接受了OGJ。在年龄（70.5岁对69.7岁，p = 0.81）、性别（女性分别为42.5%对42.3%，p = 0.99）、中位随访时间（98.0天对166.5天，p = 0.8）、既往GOO干预失败（22.5%对26.9%，p = 0.68）以及解剖结构改变情况（12.5%对30.8%，p = 0.07）方面，EUS-GE组和OGJ组的基线特征相似。EUS-GE组37例（92.5%）和OGJ组26例（100%）患者取得技术成功（p = 0.15）。EUS-GE组患者口服摄入恢复更快（1.3天对4.7天，p < 0.001），住院时间更短（5天对14.5天，p < 0.001）。在症状复发（17.5%对19.2%，风险比1.85，可信区间0.52 - 6.65，p = 0.34）、再次干预（20%对11.5%，风险比0.82，可信区间0.22 - 3.15，p = 0.78）、30天内死亡（12.5%对3.8%，风险比0.80，可信区间0.09 - 6.85，p = 0.84）或30天内再入院（17.5%对24.1%，风险比1.69，可信区间0.53 - 5.41，p = 0.37）方面，EUS-GE组和OGJ组之间均无显著差异。与OGJ组相比，EUS-GE组患者化疗开始时间更早（17.7天对31.3天，p = 0.033），总体费用更低（49387美元对124192美元，p < 0.001）。
EUS-GE组和OGJ组在技术成功或临床成功、症状复发、再次干预、3
