Unidad de Endoscopia. Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
Unidad de Endoscopia, Servicio de Digestivo, Clínica Universidad de Navarra, Pamplona, Spain.
Gastrointest Endosc. 2022 Dec;96(6):1012-1020.e3. doi: 10.1016/j.gie.2022.07.018. Epub 2022 Jul 21.
Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO) has been surgical, but surgical treatment carries significant morbidity and mortality rates. Endoscopic placement of a duodenal self-expandable metal stent (D-SEMS) has been proven to be successful for this indication in the short term. However, D-SEMSs are likely to malfunction over time. EUS-guided gastroenterostomy (EUS-GE) may help overcome these limitations. We aimed to evaluate stent failure-free survival at 3 months.
A nationwide multicenter, observational study of D-SEMS and EUS-GE procedures for patients with malignant GOO was conducted at 7 academic centers from January 2015 to June 2020. Stent failure-free survival at 1, 3, and 6 months; technical and clinical success; adverse events (AEs); and patient survival were evaluated in both groups and compared.
Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group. Pancreatic cancer was the main underlying malignancy in 53.4%. No statistically significant differences regarding technical (92.8% vs 93.7%) or clinical success (83.5% vs 92.4%) were found. AE rates did not differ between groups (10.3% vs 10.1%), although 2 events in the EUS-GE group required surgical management. Patients in the EUS-GE group had improved stent patency when compared with those patients in the D-SEMS group at 3 months (92.23% vs 80.6%; adjusted hazard ratio, .37; P = .033).
EUS-GE seems to have improved patency outcomes when compared with D-SEMS placement for palliative treatment of malignant GOO. Prospective trials are needed to fully compare their efficacy and AE profile.
传统上，恶性胃出口梗阻（GOO）的姑息性治疗是手术，但手术治疗的发病率和死亡率都很高。经内镜放置十二指肠自膨式金属支架（D-SEMS）已被证明在短期内对该适应证有效。然而，D-SEMS 随着时间的推移可能会出现故障。超声内镜引导下胃造口术（EUS-GE）可能有助于克服这些限制。我们旨在评估 3 个月时支架无故障生存率。
2015 年 1 月至 2020 年 6 月，在 7 个学术中心进行了一项全国性多中心、观察性研究，研究对象为恶性 GOO 患者的 D-SEMS 和 EUS-GE 手术。评估了两组患者 1、3 和 6 个月时的支架无故障生存率、技术和临床成功率、不良事件（AE）和患者生存率，并进行了比较。
D-SEMS 组 97 例，EUS-GE 组 79 例。53.4%的主要潜在恶性肿瘤为胰腺癌。两组之间在技术（92.8%对 93.7%）或临床成功率（83.5%对 92.4%）方面没有统计学上的显著差异。两组之间的 AE 发生率也没有差异（10.3%对 10.1%），尽管 EUS-GE 组有 2 例事件需要手术治疗。与 D-SEMS 组相比，EUS-GE 组患者的支架通畅率在 3 个月时得到改善（92.23%对 80.6%；调整后的危险比，0.37；P=0.033）。
与 D-SEMS 放置相比，EUS-GE 似乎可改善恶性 GOO 姑息性治疗的通畅率。需要前瞻性试验来充分比较它们的疗效和 AE 特征。
