Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Division of Digestive Diseases & Nutrition, University of South Florida, Tampa, Florida, USA.
Endoscopy. 2022 Jul;54(7):671-679. doi: 10.1055/a-1708-0037. Epub 2022 Feb 4.
Gastric outlet obstruction (GOO) with peritoneal carcinomatosis presents a technical challenge. Surgical gastrojejunostomy (SGJ) or enteral stenting have been the standard of care; however, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a favorable alternative. Few data exist that compare these techniques in the setting of peritoneal carcinomatosis. METHODS : This single-center retrospective cohort study included 25 EUS-GE and 27 SGJ consecutive patients. Baseline demographics, cancer diagnosis and stage, clinical and technical success, adverse events, and obstruction recurrence data were collected. The primary outcome was the technical success comparison; secondary outcome was the adverse event rate comparison. Rates were compared with standard statistical tests. RESULTS : Mean age, obstruction location, and symptoms were similar between the groups. The EUS-GE group had more advanced disease (clinical stage 4, 100 % vs. 67 %; = 0.006) and higher American Society of Anesthesiologists classification (class 3-4, 92 % vs. 50 %; = 0.004). The technical success rate was 100 % in both groups ( > 0.99) and the adverse event rate was lower for EUS-GE (8 % vs. 41 %; = 0.01). Clinical success was 88 % for EUS-GE and 85 % for SGJ ( > 0.99) and recurrent obstruction was lower with EUS-GE (28 % vs. 41 %; = 0.13). The EUS-GE group had shorter procedure duration, length of stay, and time to chemotherapy resumption than the SGJ group. CONCLUSIONS : Although the EUS-GE group was older, with more comorbidity and advanced stages, the technical success rate was similar to SGJ and it had significantly fewer adverse events. EUS-GE is a safe and effective option for the management of malignant GOO with peritoneal carcinomatosis.
伴有腹膜转移癌的胃出口梗阻（GOO）具有技术挑战性。外科胃空肠吻合术（SGJ）或肠内支架已成为标准治疗方法；然而，内镜超声引导下胃肠吻合术（EUS-GE）已成为一种有利的替代方法。在腹膜转移癌的情况下，比较这些技术的数据很少。
这项单中心回顾性队列研究包括 25 例连续 EUS-GE 和 27 例 SGJ 患者。收集了基线人口统计学数据、癌症诊断和分期、临床和技术成功率、不良事件和梗阻复发数据。主要结果是技术成功率比较；次要结果是不良事件发生率比较。用标准统计检验比较了这些比率。
两组患者的平均年龄、梗阻位置和症状相似。EUS-GE 组疾病更晚期（临床分期 4 期，100% vs. 67%；=0.006），美国麻醉医师协会分级更高（3-4 级，92% vs. 50%；=0.004）。两组的技术成功率均为 100%（>0.99），EUS-GE 的不良事件发生率较低（8% vs. 41%；=0.01）。EUS-GE 的临床成功率为 88%，SGJ 为 85%（>0.99），EUS-GE 再次梗阻率较低（28% vs. 41%；=0.13）。EUS-GE 组的手术时间、住院时间和化疗恢复时间均短于 SGJ 组。
尽管 EUS-GE 组年龄较大，合并症和晚期更多，但技术成功率与 SGJ 相似，不良事件明显较少。EUS-GE 是治疗伴有腹膜转移癌的恶性 GOO 的一种安全有效的选择。
