Asghar Muhammad, Forcione David, Puli Srinivas Reddy
Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA.
Boca Raton Regional Hospital, Boca Raton, FL, USA.
Therap Adv Gastroenterol. 2024 Jun 7;17:17562848241248219. doi: 10.1177/17562848241248219. eCollection 2024.
The symptoms of gastric outlet obstruction have traditionally been managed surgically or endoscopically. Enteral stenting (ES) is a less invasive endoscopic treatment strategy for this condition. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently become a potential alternative technique.
We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES.
Meta-analysis and systematic review.
We searched multiple databases from inception to August 2023 to identify studies that reported the effectiveness and safety of EUS-GE compared with ES. The outcomes of technical success, clinical success, and adverse events (AEs) were evaluated. Pooled proportions were calculated using both fixed and random effects models.
We included 13 studies with 1762 patients in our final analysis. The pooled rates of technical success for EUS-GE were 95.59% [95% confidence interval (CI), 94.01-97.44, = 32] and 97.96% (95% CI, 96.06-99.25, = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, = 81). The pooled odds ratio (OR) of clinical success was higher for EUS-GE compared to ES at 2.71 (95% CI, 1.87-3.93). The pooled OR of clinical success for EUS-GE was higher compared to ES at 2.72 (95% CI, 1.86-3.97, = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, = 69). The pooled OR of the rate of re-intervention in the ES group was higher at 7.96 (95% CI, 4.41-14.38, = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, = 89).
EUS-GE and ES are comparable in terms of their technical effectiveness. However, EUS-GE has demonstrated improved clinical effectiveness, a lower need for re-intervention, and a better safety profile compared to ES for palliation of gastric outlet obstruction.
胃出口梗阻的症状传统上通过手术或内镜治疗。肠道支架置入术（ES）是针对这种情况的一种侵入性较小的内镜治疗策略。内镜超声引导下胃肠造口术（EUS - GE）最近已成为一种潜在的替代技术。
我们对EUS - GE与ES的有效性和安全性进行了系统评价和荟萃分析。
荟萃分析和系统评价。
我们检索了从开始到2023年8月的多个数据库，以确定报告EUS - GE与ES相比的有效性和安全性的研究。评估了技术成功、临床成功和不良事件（AE）的结果。使用固定效应模型和随机效应模型计算合并比例。
我们最终分析纳入了13项研究，共1762例患者。EUS - GE的技术成功合并率为95.59%[95%置信区间（CI），94.01 - 97.44， = 32]，ES为97.96%（95% CI，96.06 - 99.25， = 63）。EUS - GE的临床成功合并率为93.62%（95% CI，90.76 - 95.98， = 54），而ES较低，为85.57%（95% CI，79.63 - 90.63， = 81）。与ES相比，EUS - GE临床成功的合并优势比（OR）更高，为2.71（95% CI，1.87 - 3.93）。EUS - GE临床成功的合并OR与ES相比更高，为2.72（95% CI，1.86 - 3.97， = 0）。与ES相比，EUS - GE的再次干预合并率较低，为3.77%（95% CI，1.77 - 6.46， = 44），ES为25.13%（95% CI，18.96 - 31.85， = 69）。ES组再次干预率的合并OR更高，为7.96（95% CI，4.41 - 14.38， = 13）。总体而言，EUS - GE的AE合并率为8.97%（95% CI，6.88 - 11.30， = 15），而ES为19.63%（95% CI，11.75 - 28.94， = 89）。
EUS - GE和ES在技术有效性方面具有可比性。然而，与ES相比，EUS - GE在缓解胃出口梗阻方面表现出更好的临床有效性、更低的再次干预需求和更好的安全性。
