内镜超声引导下胃-肠吻合术与十二指肠支架置入术治疗胃出口梗阻：系统评价、荟萃分析和荟萃回归。
Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for gastric outlet obstruction: A systematic review, meta-analysis, and meta-regression.
机构信息
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.
出版信息
Medicine (Baltimore). 2024 Oct 4;103(40):e39948. doi: 10.1097/MD.0000000000039948.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
背景
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。
方法
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。
结果
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。
结论
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。
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