Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Germany.
Surg Endosc. 2024 Apr;38(4):2078-2085. doi: 10.1007/s00464-024-10745-7. Epub 2024 Mar 4.
Symptomatic malignant gastric outlet obstruction (GOO) significantly reduce patients' quality of life. Endoscopic treatment involves enteral stenting or endoscopic ultrasonography to perform gastroenterostomy (EUS-GE). Aim was to compare enteral stenting with EUS-GE for endoscopic treatment of malignant GOO.
We retrospectively compared enteral stenting with EUS-GE for the treatment of malignant GOO. Patients treated at our institution were identified and a propensity score matching analysis was performed. Treatment failure was the primary outcome, while the secondary endpoints were time until treatment failure, technical and clinical success rates, and adverse event rates.
Eighty-eight patients were included in the final analysis. Of whom, 44 were included in each of the two treatment groups. Treatment failure occurred significantly more frequently in the enteral stenting group (13/44) compared with the EUS-GE group (4/44; hazard ratio: 4,9; 95% CI 1.6-15.1). A Kaplan-Meier analysis revealed a median time until treatment failure of 22.0 weeks (95% CI 4.6-39.4) in the enteral stenting group compared with 76.0 weeks (95% CI 55.9-96.1) in the EUS-GE group (P = .002). No difference in technical success and clinical success was detected. Technical success was achieved in 43/44 patients (97.7%) in the enteral stenting group compared with 41/44 patients (93.2%) in the EUS-GE group, while clinical success was achieved in 32/44 (72.7%) and 35/44 (79.5%) patients, respectively. Nine adverse events were observed (9/44, 10.2%). There were no differences in 30-day adverse event rate and 30-day mortality rate.
EUS-GE was superior to enteral stenting in the treatment of malignant GOO in terms of treatment failure and time until treatment failure in a propensity score-matched cohort.
有症状的恶性胃出口梗阻（GOO）显著降低了患者的生活质量。内镜治疗包括肠内支架置入或内镜超声检查行胃肠吻合术（EUS-GE）。本研究旨在比较肠内支架置入与 EUS-GE 内镜治疗恶性 GOO。
我们回顾性比较了肠内支架置入与 EUS-GE 治疗恶性 GOO。在我们的机构中，对接受治疗的患者进行了识别，并进行了倾向评分匹配分析。治疗失败是主要结局，次要结局包括治疗失败时间、技术和临床成功率以及不良事件发生率。
最终有 88 例患者纳入最终分析。其中，每组各有 44 例患者。肠内支架置入组（13/44）治疗失败的发生率明显高于 EUS-GE 组（4/44；风险比：4.9；95%CI 1.6-15.1）。Kaplan-Meier 分析显示，肠内支架置入组的中位治疗失败时间为 22.0 周（95%CI 4.6-39.4），而 EUS-GE 组为 76.0 周（95%CI 55.9-96.1）（P=0.002）。两组的技术成功率和临床成功率无差异。肠内支架置入组的技术成功率为 43/44 例（97.7%），EUS-GE 组为 41/44 例（93.2%），临床成功率分别为 32/44 例（72.7%）和 35/44 例（79.5%）。观察到 9 例不良事件（9/44，10.2%）。两组 30 天不良事件发生率和 30 天死亡率无差异。
在倾向评分匹配队列中，EUS-GE 在治疗恶性 GOO 的治疗失败和治疗失败时间方面优于肠内支架置入。
