Bomman Shivanand, Ghafoor Adil, Sanders David J, Jayaraj Mahendran, Chandra Shruti, Krishnamoorthi Rajesh
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States.
Department Gastroenterology and Hepatology, University of Nevada, Las Vegas, Nevada, United States.
Endosc Int Open. 2022 Apr 14;10(4):E361-E368. doi: 10.1055/a-1783-8949. eCollection 2022 Apr.
Palliative treatment of malignant gastric outlet obstruction (GOO) has conventionally been with surgical gastrojejunostomy (SGJ). Advent of devices like lumen apposing metal stents has made endoscopic ultrasound-guided gastroenterostomy (EUS-GE) a potential alternative to SGJ for these patients. We performed a systematic review and meta-analysis of studies that compared outcomes of EUS-GE versus SGJ. We performed a comprehensive systematic search of multiple electronic databases and conference proceedings through January 2021 and identified six studies that compared outcomes of EUS-GE versus SGJ in the management of malignant GOO. The rates of technical success, clinical success, and AEs were analyzed, and pooled odds ratios were calculated using random effects model. Six studies were included in our analysis with a total of 484 patients, of which 291 underwent EUS-GE and 193 underwent SGJ. The technical success rate of SGJ was superior to EUS-GE (OR = 0.195; 95 %CI:0.054-0.702; = 0.012; I = 0). The clinical success of EUS-GE was statistically similar to SGJ (OR = 1.566; 95 %CI:0.585-4.197; = 0.372; I = 46.68 %). EUS-GE had significantly fewer AEs compared to SGJ (OR = 0.295; 95 %CI:0.172-0.506; < 0.005; I = 0). Among studies which reported reintervention rates, EUS-GE was statistically similar to SGJ (OR = 0.587; 95 %CI:0.174-1.979; = 0.390, I = 54.91). Minimal to moderate heterogeneity was noted in the analyses. EUS-GE has equivalent clinical success and reintervention rates, but significantly lower adverse events compared to SGJ. When feasible, EUS-GE appears to be an effective and safe alternative to SGJ for palliative management of malignant GOO.
恶性胃出口梗阻（GOO）的姑息治疗传统上采用外科胃空肠吻合术（SGJ）。诸如管腔对接金属支架等器械的出现，使内镜超声引导下胃肠造口术（EUS-GE）成为这些患者替代SGJ的一种潜在选择。我们对比较EUS-GE与SGJ疗效的研究进行了系统评价和荟萃分析。我们对多个电子数据库和会议论文集进行了全面的系统检索，截至2021年1月，共识别出六项比较EUS-GE与SGJ治疗恶性GOO疗效的研究。分析了技术成功率、临床成功率和不良事件发生率，并使用随机效应模型计算合并比值比。我们的分析纳入了六项研究，共484例患者，其中291例行EUS-GE，193例行SGJ。SGJ的技术成功率优于EUS-GE（OR = 0.195；95%CI：0.054 - 0.702；P = 0.012；I² = 0）。EUS-GE的临床成功率与SGJ在统计学上相似（OR = 1.566；95%CI：0.585 - 4.197；P = 0.372；I² = 46.68%）。与SGJ相比，EUS-GE的不良事件显著更少（OR = 0.295；95%CI：0.172 - 0.506；P < 0.005；I² = 0）。在报告再次干预率的研究中，EUS-GE与SGJ在统计学上相似（OR = 0.587；95%CI：0.174 - 1.979；P = 0.390，I² = 54.91）。分析中发现存在轻度至中度异质性。EUS-GE具有与SGJ相当的临床成功率和再次干预率，但不良事件显著低于SGJ。在可行的情况下，EUS-GE似乎是SGJ用于恶性GOO姑息治疗的一种有效且安全的替代方法。
