Conti Bellocchi Maria Cristina, Gasparini Enrico, Stigliano Serena, Ramai Daryl, Bernardoni Laura, Di Matteo Francesco Maria, Facciorusso Antonio, Frulloni Luca, Crinò Stefano Francesco
Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy.
Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, 00128 Rome, Italy.
Cancers (Basel). 2024 Feb 8;16(4):724. doi: 10.3390/cancers16040724.
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen apposing metal stent has emerged as a minimally invasive treatment for the management of malignant gastric outlet obstruction (mGOO). We aimed to compare EUS-GE with enteral stenting (ES) for the treatment of mGOO.
Patients who underwent EUS-GE or ES for mGOO between June 2017 and June 2023 at two Italian centers were retrospectively identified. The primary outcome was stent dysfunction. Secondary outcomes included technical success, clinical failure, safety, and hospital length of stay. A propensity score-matching analysis was performed using multiple covariates.
Overall, 198 patients were included (66 EUS-GE and 132 ES). The stent dysfunction rate was 3.1% and 16.9% following EUS-GE and ES, respectively ( = 0.004). Using propensity score-matching, 45 patients were allocated to each group. The technical success rate was 100% for both groups. Stent dysfunction was higher in the ES group compared with the EUS-GE group (20% versus 4.4%, respectively; = 0.022) without differences in clinical efficacy ( = 0.266) and safety ( = 0.085). A significantly shorter hospital stay was associated with EUS-GE compared with ES (7.5 ± 4.9 days vs. 12.5 ± 13.0 days, respectively; = 0.018). Kaplan-Meier analyses confirmed a higher stent dysfunction-free survival rate after EUS-GE compared with ES (log-rank test; = 0.05).
EUS-GE offers lower rates of stent dysfunction, longer stent patency, and shorter hospital stay compared with ES.
使用管腔对吻金属支架的内镜超声引导下胃肠吻合术（EUS-GE）已成为治疗恶性胃出口梗阻（mGOO）的一种微创治疗方法。我们旨在比较EUS-GE与肠内支架置入术（ES）治疗mGOO的效果。
回顾性纳入2017年6月至2023年6月在意大利两个中心接受EUS-GE或ES治疗mGOO的患者。主要结局是支架功能障碍。次要结局包括技术成功率、临床失败率、安全性和住院时间。使用多个协变量进行倾向评分匹配分析。
总体上，共纳入198例患者（66例行EUS-GE，132例行ES）。EUS-GE和ES术后的支架功能障碍率分别为3.1%和16.9%（P = 0.004）。使用倾向评分匹配后，每组分配45例患者。两组的技术成功率均为100%。ES组的支架功能障碍率高于EUS-GE组（分别为20%和4.4%；P = 0.022），而临床疗效（P = 0.266）和安全性（P = 0.085）无差异。与ES相比，EUS-GE的住院时间明显更短（分别为7.5±4.9天和12.5±13.0天；P = 0.018）。Kaplan-Meier分析证实，与ES相比，EUS-GE术后无支架功能障碍生存率更高（对数秩检验；P = 0.05）。
与ES相比，EUS-GE的支架功能障碍率更低，支架通畅时间更长，住院时间更短。
