Sobani Zain A, Paleti Swathi, Rustagi Tarun
Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States.
Endosc Int Open. 2021 Jun;9(6):E895-E900. doi: 10.1055/a-1399-8442. Epub 2021 May 27.
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a 15-mm lumen apposing metal stent (LAMS) has emerged as a viable alternative to surgical gastrojejunostomy for management of gastric outlet obstruction (GOO). However, given the size of the anastomosis created with a 15-mm LAMS, long-term luminal patency and clinical outcomes may be suboptimal. The aim of this study was to evaluate the technical feasibility, efficacy, and safety of EUS-GE with a large-diameter (20 mm) LAMS (LLAMS). A retrospective analysis of a prospectively maintained database of all patients undergoing EUS-GE with LLAMS between December 1, 2018 and September 30, 2020 was performed. All EUS-GEs were performed using a cautery-enhanced LLAMS. Thirty-three patients were referred for endoscopic management of GOO. Two patients were excluded due to a lack of an adequate window for EUS-GE. The remaining 31 patients (93.94 %) (mean age: 61.35 ± 16.52 years; 54.84 % males) underwent EUS-GE using LLAMS for malignant (n = 23) and benign (n = 8) GOO. Technical success was achieved in all patients (100 %) with attempted EUS-GE. Complete clinical success (tolerance of regular diet) was achieved in 93.55 % of patients (n = 29). Two patients (6.45 %) had partial clinical success and died of unrelated causes prior to advancing diet beyond full liquids. Overall mean follow-up was 140.84 ± 160.41 days (median 70, range 4-590). All stents remained patent with no evidence of recurrent GOO symptoms. One patient (3.23 %) developed an asymptomatic clean-based jejunal ulcer on 3-month follow-up endoscopy. EUS-GE with LLAMS is a technically feasible, effective and safe option for patients with GOO allowing for tolerability of regular diet. Future prospective, ideally randomized studies comparing long-term outcomes of EUS-GE with 20- and 15-mm LAMS are required.
使用15毫米管腔对接金属支架（LAMS）的内镜超声引导下胃肠造口术（EUS-GE）已成为治疗胃出口梗阻（GOO）的手术胃空肠吻合术的一种可行替代方案。然而，考虑到用15毫米LAMS创建的吻合口大小，长期管腔通畅性和临床结果可能并不理想。本研究的目的是评估使用大直径（20毫米）LAMS（LLAMS）进行EUS-GE的技术可行性、有效性和安全性。对2018年12月1日至2020年9月30日期间所有接受LLAMS EUS-GE的患者的前瞻性维护数据库进行了回顾性分析。所有EUS-GE均使用烧灼增强型LLAMS进行。33例患者因GOO接受内镜治疗。2例患者因缺乏足够的EUS-GE窗口而被排除。其余31例患者（93.94%）（平均年龄：61.35±16.52岁；54.84%为男性）因恶性（n = 23）和良性（n = 8）GOO接受了LLAMS EUS-GE。所有尝试进行EUS-GE的患者均取得技术成功（100%）。93.55%的患者（n = 29）取得完全临床成功（能耐受常规饮食）。2例患者（6.45%）取得部分临床成功，并在饮食进展超过全流食之前死于无关原因。总体平均随访时间为140.84±160.41天（中位数70天，范围4 - 590天）。所有支架均保持通畅，无复发性GOO症状的证据。1例患者（3.23%）在3个月的随访内镜检查中出现无症状的清洁基底空肠溃疡。对于GOO患者，LLAMS EUS-GE是一种技术可行、有效且安全的选择，能使患者耐受常规饮食。未来需要进行前瞻性、理想情况下为随机对照的研究，比较20毫米和15毫米LAMS的EUS-GE的长期结果。
