Abdallah Shenouda, Dabas Muath M, Morcos Rami K, Rehman Abdur, Shehryar Abdullah, Orakzai Asif, Sivadasan Manukrishna, Zia Talha A, Anika Nabila N, Abushalha Nada B, Jameel Syed
Surgery, Jaber Al-Ahmad Hospital, Kuwait, KWT.
Surgery, The University of Jordan, Amman, JOR.
Cureus. 2024 Nov 14;16(11):e73690. doi: 10.7759/cureus.73690. eCollection 2024 Nov.
Gastric outlet obstruction (GOO) is a clinical condition that can arise from both benign and malignant causes, requiring effective management strategies to ensure optimal patient outcomes. Traditionally, open surgical techniques like gastrojejunostomy (GJ) have been the standard treatment, but recent advances in minimally invasive procedures, such as endoscopic ultrasound-guided gastroenterostomy (EUS-GE), offer alternative approaches with potentially reduced morbidity. This systematic review compared the efficacy, safety, and clinical outcomes of endoscopic versus open surgical techniques in managing GOO. A comprehensive search of major electronic databases, including PubMed, MEDLINE, Embase, the Cochrane Library, and Scopus, identified relevant studies published from January 2014 to September 2024. The analysis included randomized controlled trials, clinical trials, and meta-analyses involving a total of 8,540 patients. Results indicated that EUS-GE showed high technical and clinical success rates (91-94% and 88-89.9%, respectively) and lower complication rates (6.8-13.1%) compared to open surgical approaches, which were associated with higher perioperative risks but demonstrated better long-term outcomes in specific scenarios, such as malignant GOO. The findings suggest that while endoscopic techniques are preferable for patients with high surgical risk, open surgery may still be necessary in complex cases. Further research, including randomized controlled trials and long-term studies, is recommended to refine these strategies and improve clinical decision-making. This review underscores the importance of tailored treatment approaches in optimizing the management of GOO, balancing efficacy, safety, and patient-centered outcomes.
胃出口梗阻（GOO）是一种临床病症，可由良性和恶性原因引起，需要有效的管理策略以确保患者获得最佳预后。传统上，诸如胃空肠吻合术（GJ）等开放手术技术一直是标准治疗方法，但近年来，微创技术如内镜超声引导下胃肠造口术（EUS-GE）取得了进展，提供了具有潜在更低发病率的替代方法。本系统评价比较了内镜技术与开放手术技术在治疗GOO方面的疗效、安全性和临床结局。对包括PubMed、MEDLINE、Embase、Cochrane图书馆和Scopus在内的主要电子数据库进行全面检索，确定了2014年1月至2024年9月发表的相关研究。分析纳入了随机对照试验、临床试验和荟萃分析，共涉及8540例患者。结果表明，与开放手术方法相比，EUS-GE显示出较高的技术成功率和临床成功率（分别为91%-94%和88%-89.9%）以及较低的并发症发生率（6.8%-13.1%），开放手术方法围手术期风险较高，但在特定情况下（如恶性GOO）显示出更好的长期结局。研究结果表明，虽然内镜技术对于手术风险高的患者更可取，但在复杂病例中可能仍需要开放手术。建议进一步开展研究，包括随机对照试验和长期研究，以完善这些策略并改善临床决策。本综述强调了在优化GOO管理中采用个性化治疗方法的重要性，平衡疗效、安全性和以患者为中心的结局。
