Pancreatobiliary Endoscopy and Endosonography Division.
Pancreatobiliary Endoscopy and Endosonography Division.
Gastrointest Endosc. 2023 Sep;98(3):337-347.e5. doi: 10.1016/j.gie.2023.04.2072. Epub 2023 Apr 23.
Retrospective studies on malignant gastric outlet obstruction (mGOO) highlighted several advantages of EUS-guided gastroenterostomy (EUS-GE) over enteral stenting (ES). However, no prospective evidence is available. The aim of this study was to report on clinical outcomes of EUS-GE in a prospective cohort study, with a subgroup comparison versus ES.
All consecutive patients endoscopically treated for mGOO between December 2020 and December 2022 in a tertiary, academic center were enrolled in a prospective registry (Prospective Registry of Therapeutic Endoscopic Ultrasound [PROTECT]; NCT04813055) and followed up every 30 days to register efficacy/safety outcomes. EUS-GE and ES cohorts were matched according to baseline frailty and oncologic disease.
A total of 104 patients were treated for mGOO during the study; 70 (58.6% male subjects; median age, 64 [interquartile range, 58-73] years; 75.7% pancreatic cancer, 60.0% metastatic cancer) underwent EUS-GE via the wireless simplified technique. Technical success was 97.1% and clinical success was 97.1% after a median of 1.5 (interquartile range, 1-2) days. Adverse events occurred in 9 (12.9%) patients. After a median follow-up of 105 (49-187) days, symptom recurrence was 7.6%. In the matched comparison versus ES (28 patients per arm), EUS-GE-treated patients experienced higher and faster clinical success (100% vs 75.0%, P = .006), reduced recurrences (3.7% vs 33.3%, P = .02), and a trend toward shorter time to chemotherapy.
In this first, prospective, single-center comparison, EUS-GE showed excellent efficacy in treating mGOO, with an acceptable safety profile and long-term patency, and several clinically significant advantages over ES. While awaiting randomized trials, these results might endorse EUS-GE as first-line strategy for mGOO, where adequate expertise is available.
回顾性研究表明，超声内镜引导下胃肠吻合术（EUS-GE）治疗恶性胃出口梗阻（mGOO）优于肠内支架置入术（ES），具有多项优势。然而，目前尚无前瞻性证据。本研究旨在报告一项前瞻性队列研究中 EUS-GE 的临床结果，并与 ES 进行亚组比较。
2020 年 12 月至 2022 年 12 月，在一家三级学术中心接受 mGOO 内镜治疗的所有连续患者均被纳入前瞻性登记处（治疗性超声内镜前瞻性登记处 [PROTECT]；NCT04813055），并每 30 天随访一次，以登记疗效/安全性结果。根据基线虚弱和肿瘤疾病，EUS-GE 和 ES 队列进行匹配。
研究期间共 104 例患者因 mGOO 接受治疗；70 例（58.6%男性患者；中位年龄 64 [四分位距 58-73] 岁；75.7%胰腺癌，60.0%转移性癌症）采用无线简化技术进行 EUS-GE。技术成功率为 97.1%，中位 1.5 天（四分位距 1-2 天）后临床成功率为 97.1%。9 例（12.9%）患者发生不良事件。中位随访 105（49-187）天后，症状复发率为 7.6%。在与 ES（每组 28 例）的匹配比较中，EUS-GE 治疗组的患者更早更快地获得临床成功（100% vs 75.0%，P =.006），复发率更低（3.7% vs 33.3%，P =.02），且接受化疗的时间更短。
在这项首次前瞻性单中心比较中，EUS-GE 治疗 mGOO 的疗效出色，安全性良好，长期通畅，与 ES 相比具有多项临床优势。在等待随机试验的同时，这些结果可能支持 EUS-GE 作为 mGOO 的一线治疗策略，只要有足够的专业知识。
