Martins Rafael Krieger, Brunaldi Vitor Ottoboni, Fernandes André Luis, Otoch José Pinhata, Artifon Everson Luiz de Almeida
Postgraduate Program of Anesthesiology, Surgical Sciences and Perioperative Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 255 - Cerqueira César, São Paulo, São Paulo 05403-000, Brazil.
Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil.
Ther Adv Gastrointest Endosc. 2023 Jan 21;16:26317745221149626. doi: 10.1177/26317745221149626. eCollection 2023 Jan-Dec.
The gold-standard procedure to address malignant gastric outlet obstruction (MGOO) is surgical gastrojejunostomy (SGJJ). Two endoscopic alternatives have also been proposed: the endoscopic stenting (ES) and the endoscopic ultrasound-guided gastroenterostomy (EUS-G). This study aimed to perform a thorough and strict meta-analysis to compare EUS-G with the SGJJ and ES in treating patients with MGOO.
Studies comparing EUS-G to endoscopic stenting or SGJJ for patients with MGOO were considered eligible. We conducted online searches in primary databases (MEDLINE, EMBASE, Lilacs, and Central Cochrane) from inception through October 2021. The outcomes were technical and clinical success rates, serious adverse events (SAEs), reintervention due to obstruction, length of hospital stay (LOS), and time to oral intake.
We found similar technical success rates between ES and EUS-G but clinical success rates favored the latter. The comparison between EUS-G and SGJJ demonstrated better technical success rates in favor of the surgical approach but similar clinical success rates. EUS-G shortens the LOS by 2.8 days compared with ES and 5.8 days compared with SGJJ. Concerning reintervention due to obstruction, we found similar rates for EUS-G and SGJJ but considerably higher rates for ES compared with EUS-G. As to AEs, we demonstrated equivalent rates comparing EUS-G and SGJJ but significantly higher ones compared with ES.
Despite being novel and still under refinement, the EUS-G has good safety and efficacy profiles compared with SGJJ and ES.
治疗恶性胃出口梗阻（MGOO）的金标准手术是外科胃空肠吻合术（SGJJ）。另外还提出了两种内镜替代方法：内镜支架置入术（ES）和内镜超声引导下胃肠吻合术（EUS-G）。本研究旨在进行全面且严格的荟萃分析，以比较EUS-G与SGJJ和ES在治疗MGOO患者中的效果。
比较EUS-G与内镜支架置入术或SGJJ治疗MGOO患者的研究被视为合格研究。我们在主要数据库（MEDLINE、EMBASE、Lilacs和Cochrane中心对照试验注册库）中进行了从建库至2021年10月的在线检索。结局指标包括技术成功率、临床成功率、严重不良事件（SAE）、因梗阻进行的再次干预、住院时间（LOS）以及开始经口进食的时间。
我们发现ES和EUS-G的技术成功率相似，但临床成功率更倾向于后者。EUS-G与SGJJ的比较显示，手术方法的技术成功率更高，但临床成功率相似。与ES相比，EUS-G使LOS缩短了2.8天，与SGJJ相比缩短了5.8天。关于因梗阻进行的再次干预，我们发现EUS-G和SGJJ的发生率相似，但ES的发生率与EUS-G相比显著更高。至于不良事件，我们证明EUS-G和SGJJ的发生率相当，但与ES相比显著更高。
尽管EUS-G是一种新方法且仍在完善中，但与SGJJ和ES相比，它具有良好的安全性和有效性。
