Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Jodhpur, India.
Department of Internal Medicine, Medical College Kolkata, Kolkata, West Bengal, India.
Medicine (Baltimore). 2024 Oct 4;103(40):e39948. doi: 10.1097/MD.0000000000039948.
Gastric outlet obstruction (GOO) refers to mechanical obstruction at the level of the gastric outlet and is associated with significantly impacted quality of life and mortality. Duodenal stenting (DS) offers a minimally invasive approach to managing GOO but is associated with a high risk of stent obstruction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel intervention that uses lumen-apposing metal stents to open the restricted lumen. The current evidence comparing EUS-GE to DS is limited and inconsistent.
We conducted a systematic literature search on PubMed, Embase, Cochrane, Scopus, and clinicaltrials.gov to retrieve studies comparing EUS-GE to DS for GOO. Odds ratios (OR) and mean differences (MD) with their 95% confidence intervals (CI) were pooled using the DerSimonian-Laird inverse variance random-effects model. Statistical significance was set at P < .05.
Ten studies with a total of 1275 GOO patients (585: EUS-GE and 690: DS) were included. EUS-GE was associated with statistically significant higher clinical success [OR: 2.52; 95% CI: 1.64, 3.86; P < .001], lower re-intervention rate [OR: 0.12; 95% CI: 0.06, 0.22; P < .00001], longer procedural time [MD: 20.91; 95% CI: 15.48, 26.35; P < .00001], and lower risk of adverse events [OR: 0.49; 95% CI: 0.29, 0.82; P = .007] than DS. Technical success [OR: 0.62; 95% CI: 0.31, 1.25] and the length of hospital stay [MD: -2.12; 95% CI: -5.23, 0.98] were comparable between the 2 groups.
EUS-GE is associated with higher clinical success, longer total procedural time, lower re-intervention rate, and lower risk of adverse events than DS. Technical success and the length of hospital stay were comparable between the 2 groups. EUS-GE appears to be a safe and effective procedure for managing GOO. Further large, multicentric randomized controlled trials are warranted to investigate the safety and outcomes of EUS-GE in patients with malignant GOO.
胃出口梗阻（GOO）是指胃出口水平的机械性梗阻，与生活质量显著受影响和死亡率显著升高相关。十二指肠支架置入术（DS）为管理 GOO 提供了一种微创方法，但与支架阻塞的高风险相关。内镜超声引导下胃肠吻合术（EUS-GE）是一种新的介入方法，它使用腔镜贴合金属支架来打开受限的管腔。目前比较 EUS-GE 与 DS 治疗 GOO 的证据有限且不一致。
我们在 PubMed、Embase、Cochrane、Scopus 和 clinicaltrials.gov 上进行了系统文献检索，以检索比较 EUS-GE 与 DS 治疗 GOO 的研究。使用 DerSimonian-Laird 逆方差随机效应模型汇总比值比（OR）和均数差值（MD）及其 95%置信区间（CI）。统计显著性设为 P <.05。
共纳入 10 项研究，总计 1275 例 GOO 患者（EUS-GE 组 585 例，DS 组 690 例）。EUS-GE 与更高的临床成功率显著相关[OR：2.52；95%CI：1.64，3.86；P <.001]、更低的再干预率[OR：0.12；95%CI：0.06，0.22；P <.00001]、更长的手术时间[MD：20.91；95%CI：15.48，26.35；P <.00001]和更低的不良事件风险[OR：0.49；95%CI：0.29，0.82；P =.007]，而 DS 组则无统计学意义。2 组间技术成功率[OR：0.62；95%CI：0.31，1.25]和住院时间[MD：-2.12；95%CI：-5.23，0.98]无显著差异。
EUS-GE 与更高的临床成功率、更长的总手术时间、更低的再干预率和更低的不良事件风险相关，而 DS 组则无统计学意义。2 组间技术成功率和住院时间无显著差异。EUS-GE 似乎是一种安全有效的治疗 GOO 的方法。需要进一步进行大型、多中心随机对照试验，以研究恶性 GOO 患者 EUS-GE 的安全性和结果。
