Miller Corey, Benchaya Joshua A, Martel Myriam, Barkun Alan, Wyse Jonathan M, Ferri Lorenzo, Chen Yen-I
Division of Gastroenterology, Department of Medicine, Jewish General Hospital, Montreal, Canada.
Division of Experimental Medicine, Department of Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, Canada.
Endosc Int Open. 2023 Jul 26;11(7):E660-E672. doi: 10.1055/a-2098-2570. eCollection 2023 Jul.
Malignant gastric outlet obstruction (MGOO) is traditionally treated with surgical gastrojejunostomy (SGJ), which is effective but associated with high rates of morbidity, or endoscopic stenting (ES), which is less invasive but associated with significant risk of stent dysfunction and need for reintervention. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) provides a robust bypass without the invasiveness of surgery. We performed a systematic review and meta-analysis comparing EUS-GE to SGJ and ES for MGOO. Electronic databases were searched from inception through February 2022. A meta-analysis was performed with results reported as odds ratios (ORs) with 95% confidence intervals (CIs) using random effects models. Primary outcomes included clinical success without recurrent GOO and adverse events (AEs). Sixteen studies involving 1541 patients were included. EUS-GE was associated with higher clinical success without recurrent GOO compared to ES or SGJ [OR 2.60, 95% CI1.58-4.28] and compared to ES alone [OR 5.08, 95% CI 3.42-7.55], but yielded no significant difference compared to SGJ alone [OR 1.94, 95% CI 0.97-3.88]. AE rates were significantly lower for EUS-GE compared to ES or SGJ grouped together [OR 0.34, 95% CI 0.20-0.58], or SGJ alone [OR 0.17, 95% CI 0.10-0.30] but were not significant different versus ES alone [OR 0.57, 95% CI 0.29-1.14]. EUS-GE is the most successful approach to treating MGOO, exhibiting a lower risk of recurrent obstruction compared to ES, and fewer AEs compared to SGJ.
恶性胃出口梗阻（MGOO）传统上采用外科胃空肠吻合术（SGJ）治疗，该方法有效，但发病率较高；或者采用内镜支架置入术（ES），该方法侵入性较小，但支架功能障碍和再次干预的风险较高。内镜超声引导下胃造瘘术（EUS-GE）提供了一种无需手术侵入性的有效旁路。我们进行了一项系统评价和荟萃分析，比较EUS-GE与SGJ和ES治疗MGOO的效果。从数据库建立至2022年2月进行电子数据库检索。采用随机效应模型进行荟萃分析，结果以比值比（OR）和95%置信区间（CI）报告。主要结局包括无复发性胃出口梗阻的临床成功率和不良事件（AE）。纳入了16项研究，共1541例患者。与ES或SGJ相比，EUS-GE无复发性胃出口梗阻的临床成功率更高[OR 2.60，95%CI 1.58-4.28]，与单独ES相比[OR 5.08，95%CI 3.42-7.55]，但与单独SGJ相比无显著差异[OR 1.94，95%CI 0.97-3.88]。与ES或SGJ合并组相比，EUS-GE的AE发生率显著更低[OR 0.34，95%CI 0.20-0.58]，与单独SGJ相比[OR 0.17，95%CI 0.10-0.30]，但与单独ES相比无显著差异[OR 0.57，95%CI 0.29-1.14]。EUS-GE是治疗MGOO最成功的方法，与ES相比，复发性梗阻风险更低，与SGJ相比，AE更少。
