Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Scand J Gastroenterol. 2021 Aug;56(8):972-977. doi: 10.1080/00365521.2021.1925338. Epub 2021 Jul 8.
EUS-guided gastroenterostomy (EUS-GE) with lumen-apposing metallic stents (LAMS) in patients with gastric outlet obstruction (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. In severely ill patients, the method can provide improved quality of life (QoL) and symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine.
To assess the technical and clinical success and safety of EUS-GE.
A dual center retrospective case series of 33 consecutive patients with GOO due to malignant ( = 28) or non-malignant conditions ( = 5). The patients were treated with EUS-GE using cautery enhanced LAMS. Procedures were performed guided by EUS and fluoroscopy in general anesthesia or conscious sedation.
Technical success was achieved in all patients. The median procedure time was 71 min and the median hospital stay was three days. Thirty (91%) patients were able to resume oral nutrition after the procedure. Ten patients (30%) experienced adverse events (AEs), including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12%). All stent-related AEs were handled endoscopically. Five patients (15%) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5-76), and 13 patients with obstructing malignancies lived 12 weeks or longer.
EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The method has potential hazards and should only be offered in expert centers that regularly perform the procedure.
超声内镜引导下胃造口术（EUS-GE）联合内镜下黏膜吻合术用金属支架（LAMS）治疗胃出口梗阻（GOO）已被证明是一种替代十二指肠内支架和外科胃造口术的方法。在病情严重的患者中，该方法可以通过恢复液体和营养物质向小肠的腔道通畅来提高生活质量（QoL）并缓解症状。
评估 EUS-GE 的技术和临床成功率及安全性。
一项回顾性的双中心病例系列研究，纳入了 33 例因恶性（ = 28）或非恶性疾病（ = 5）导致 GOO 的连续患者。这些患者采用电凝增强型 LAMS 行 EUS-GE 治疗。在全身麻醉或清醒镇静下，通过超声内镜和透视引导进行操作。
所有患者均达到技术成功。中位手术时间为 71 分钟，中位住院时间为 3 天。30 例（91%）患者术后可恢复口服营养。10 例（30%）患者发生不良事件（AEs），包括支架迁移、出血和感染。4 例患者发生致命性 AEs（12%）。所有与支架相关的 AEs 均经内镜处理。5 例（15%）患者需要再次介入治疗。恶性梗阻患者的中位生存时间为 8.5 周（0.5-76），13 例恶性梗阻患者的生存时间达到 12 周或更长。
EUS-GE 是一种微创且有效的恢复胃肠道通畅的方法，可改善 GOO 患者的姑息治疗效果。该方法存在潜在风险，仅应在常规开展该手术的专家中心提供。
