Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
Gastroenterology Department, Clínica Universitaria de Navarra, Navarra, Pamplona, Spain.
Gastrointest Endosc. 2023 Jul;98(1):28-35. doi: 10.1016/j.gie.2023.02.015. Epub 2023 Feb 18.
EUS-guided gastroenterostomy (EUS-GE) is increasingly used for malignant gastric outlet obstruction (GOO) in inoperable patients. However, the impact of EUS-GE on patient quality of life (QoL) has not been evaluated prospectively.
Consecutive patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at 4 Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 at baseline and 1 month after the procedure. Centralized follow-up by telephone calls was undertaken. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS ≥2. Differences between baseline and 30-day QoL scores were assessed using a linear mixed model.
Sixty-four patients were enrolled, 33 (51.6%) men, with a median age of 77.3 years (interquartile range, 65.5-86.5). The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven patients (57.9%) presented a 2/3 baseline Eastern Cooperative Oncology Group performance status score. Oral intake was restarted within 48 hours in 61 patients (95.3%), and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale was documented, with significant improvements in nausea and vomiting, pain, constipation, and appetite loss.
EUS-GE relieves GOO symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in QoL scores at 30 days from baseline. (Clinical trial registration number: NCT04660695.).
超声内镜引导下胃造口术（EUS-GE）越来越多地用于无法手术的恶性胃出口梗阻（GOO）患者。然而，EUS-GE 对患者生活质量（QoL）的影响尚未进行前瞻性评估。
2019 年 8 月至 2021 年 5 月，4 家西班牙中心连续入组因不可切除的恶性 GOO 而行 EUS-GE 的患者，分别在基线和术后 1 个月使用欧洲癌症研究与治疗组织生活质量问卷核心 30 量表进行前瞻性评估。通过电话进行集中随访。采用胃出口梗阻评分系统（GOOSS）评估经口摄入情况，定义临床成功为 GOOSS≥2。使用线性混合模型评估基线和 30 天 QoL 评分之间的差异。
共入组 64 例患者，其中男 33 例（51.6%），中位年龄为 77.3 岁（四分位距 65.5-86.5）。最常见的诊断为胰腺（35.9%）和胃（31.3%）腺癌。37 例（57.9%）患者基线时 Eastern Cooperative Oncology Group 表现状态评分为 2/3 分。61 例（95.3%）患者在 48 小时内重新开始经口摄入，术后中位住院时间为 3.5 天（四分位距 2-5）。30 天临床成功率为 83.3%。记录到全球健康状况量表评分显著增加 21.6 分（95%置信区间，11.5-31.7），恶心和呕吐、疼痛、便秘和食欲丧失等方面有显著改善。
EUS-GE 可缓解无法手术的恶性肿瘤患者的 GOO 症状，使患者能够快速经口摄入并出院。它还能在 30 天内显著提高 QoL 评分。（临床试验注册号：NCT04660695.）
