Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands.
Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy.
Endoscopy. 2022 Nov;54(11):1023-1031. doi: 10.1055/a-1782-7568. Epub 2022 Mar 24.
Endoscopic duodenal stenting is the current standard treatment for malignant gastric outlet obstruction (GOO) in patients with limited life expectancy. However, duodenal stenting is prone to stent dysfunction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique with potentially superior stent patency. We compared clinical success, safety, and stent dysfunction of EUS-GE and duodenal stenting in patients with malignant GOO using propensity score matching.
This international, multicenter, retrospective study analyzed consecutive patients undergoing EUS-GE or duodenal stenting for GOO between 2015 and 2021 in three European centers. Primary outcomes were clinical success (GOO scoring system [GOOSS] ≥ 2) and stent dysfunction (GOOSS ≤ 1 after initial clinical success). A propensity score matching (1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites, and peritoneal carcinomatosis as variables.
214 patients underwent EUS-GE (n = 107) or duodenal stenting (n = 107). After propensity score matching, 176 patients were matched and compared. Technical success rates for EUS-GE and duodenal stenting were 94 % (95 %CI 89 %-99 %) vs. 98 % (95 %CI 95 %-100 %), respectively ( = 0.44). Clinical success rates were 91 % (95 %CI 85 %-97 %) vs. 75 % (95 %CI 66 %-84 %; = 0.008). Stent dysfunction occurred in 1 % (95 %CI 0-4 %) vs. 26 % (95 %CI 15 %-37 %) of patients ( < 0.001). Adverse event rate was 10 % (95 %CI 4 %-17 %) vs. 21 % (95 %CI 12 %-29 %; = 0.09).
EUS-GE had higher clinical success and lower stent dysfunction, with similar safety, compared with duodenal stenting, suggesting that EUS-GE may be preferred over duodenal stenting in patients with malignant GOO.
对于预期寿命有限的恶性胃出口梗阻（GOO）患者，内镜十二指肠支架置入术是目前治疗该病的标准方法。然而，十二指肠支架置入术容易出现支架功能障碍。内镜超声引导下胃肠造口术（EUS-GE）是一种新型技术，具有潜在的更好的支架通畅性。我们通过倾向评分匹配比较了 EUS-GE 和十二指肠支架置入术治疗恶性 GOO 患者的临床成功率、安全性和支架功能障碍。
这是一项国际多中心回顾性研究，分析了 2015 年至 2021 年期间在欧洲三个中心接受 EUS-GE 或十二指肠支架置入术治疗 GOO 的连续患者。主要结局是临床成功率（GOO 评分系统[GOOSS]≥2）和支架功能障碍（初始临床成功后 GOOSS≤1）。使用年龄、性别、基础疾病、疾病分期、腹水和腹膜癌病作为变量进行倾向评分匹配（1:1）分析。
214 例患者接受了 EUS-GE（n=107）或十二指肠支架置入术（n=107）。经过倾向评分匹配后，176 例患者进行了匹配和比较。EUS-GE 和十二指肠支架置入术的技术成功率分别为 94%（95%CI 89%-99%）和 98%（95%CI 95%-100%）（ =0.44）。临床成功率分别为 91%（95%CI 85%-97%）和 75%（95%CI 66%-84%； =0.008）。支架功能障碍分别发生在 1%（95%CI 0-4%）和 26%（95%CI 15%-37%）的患者中（ <0.001）。不良事件发生率分别为 10%（95%CI 4%-17%）和 21%（95%CI 12%-29%）（ =0.09）。
与十二指肠支架置入术相比，EUS-GE 具有更高的临床成功率和更低的支架功能障碍，且安全性相似，提示 EUS-GE 可能优于十二指肠支架置入术，用于治疗恶性 GOO 患者。
