同一手术日内行双超声内镜引导下旁路吻合术与外科胃空肠吻合术和肝胆管空肠吻合术的对比：一项国际多中心比较研究。
Same-session double EUS-guided bypass versus surgical gastroenterostomy and hepaticojejunostomy: an international multicenter comparison.
机构信息
Department of Gastroenterology and Hepatology; Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, Bonheiden, Belgium.
Pancreatobiliary Endoscopy and Endosonography Division.
出版信息
Gastrointest Endosc. 2023 Aug;98(2):225-236.e1. doi: 10.1016/j.gie.2023.03.019. Epub 2023 Mar 27.
BACKGROUND AND AIMS
Gastric outlet and biliary obstruction are common manifestations of GI malignancies and some benign diseases for which standard treatment would be surgical gastroenterostomy and hepaticojejunostomy (ie, "double bypass"). Therapeutic EUS has allowed for the creation of an EUS-guided double bypass. However, same-session double EUS-guided bypass has only been described in small proof-of-concept series and lacks a comparison with surgical double bypass.
METHODS
A retrospective multicenter analysis was performed of all consecutive same-session double EUS-guided bypass procedures performed in 5 academic centers. Surgical comparators were extracted from these centers' databases from the same time interval. Efficacy, safety, hospital stay, nutrition and chemotherapy resumption, long-term patency, and survival were compared.
RESULTS
Of 154 identified patients, 53 (34.4%) received treatment with EUS and 101 (65.6%) with surgery. At baseline, patients undergoing EUS exhibited higher American Society of Anesthesiologists scores and a higher median Charlson Comorbidity Index (9.0 [interquartile range {IQR}, 7.0-10.0] vs 7.0 [IQR, 5.0-9.0], P < .001). Technical success (96.2% vs 100%, P = .117) and clinical success rates (90.6% vs 82.2%, P = .234) were similar when comparing EUS and surgery. Overall (11.3% vs 34.7%, P = .002) and severe adverse events (3.8% vs 19.8%, P = .007) occurred more frequently in the surgical group. In the EUS group, median time to oral intake (0 days [IQR, 0-1] vs 6 days [IQR, 3-7], P < .001) and hospital stay (4.0 days [IQR, 3-9] vs 13 days [IQR, 9-22], P < .001) were significantly shorter.
CONCLUSIONS
Despite being used in a patient population with more comorbidities, same-session double EUS-guided bypass achieved similar technical and clinical success and was associated with fewer overall and severe adverse events when compared with surgical gastroenterostomy and hepaticojejunostomy.
背景与目的
胃出口和胆道梗阻是 GI 恶性肿瘤和一些良性疾病的常见表现，其标准治疗方法是外科胃空肠吻合术和肝胆管空肠吻合术（即“双旁路”）。治疗性超声内镜（EUS）的出现使得 EUS 引导下的双旁路成为可能。然而，同种术式的双 EUS 引导旁路仅在小的概念验证系列中有所描述，并且缺乏与外科双旁路的比较。
方法
对 5 个学术中心进行的所有连续同种术式双 EUS 引导旁路手术进行回顾性多中心分析。从同一时间段内的这些中心的数据库中提取外科对照组。比较了疗效、安全性、住院时间、营养和化疗恢复、长期通畅率和生存率。
结果
在 154 名确定的患者中，53 名（34.4%）接受 EUS 治疗，101 名（65.6%）接受手术治疗。在基线时，接受 EUS 治疗的患者的美国麻醉医师协会评分和Charlson 合并症指数中位数更高（9.0[四分位距{IQR}，7.0-10.0]比 7.0[IQR，5.0-9.0]，P<0.001）。EUS 与手术组的技术成功率（96.2%比 100%，P=0.117）和临床成功率（90.6%比 82.2%，P=0.234）相似。EUS 组（11.3%比 34.7%，P=0.002）和严重不良事件（3.8%比 19.8%，P=0.007）的总发生率和严重不良事件发生率更高。EUS 组的中位开始口服摄入时间（0 天[IQR，0-1]比 6 天[IQR，3-7]，P<0.001）和住院时间（4.0 天[IQR，3-9]比 13 天[IQR，9-22]，P<0.001）明显缩短。
结论
尽管在合并症较多的患者中使用，但同种术式的双 EUS 引导旁路与外科胃空肠吻合术和肝胆管空肠吻合术相比，技术和临床成功率相似，且总不良事件和严重不良事件发生率较低。
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