Yang Chi-Ying, Huang Wen-Hsin, Cheng Hsing-Hung
Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Clin Endosc. 2025 Mar;58(2):201-217. doi: 10.5946/ce.2024.206. Epub 2025 Mar 4.
Gastric outlet obstruction (GOO) is a condition characterized by a mechanical obstruction of the stomach or duodenum, caused by either benign or malignant disease. Traditionally, surgical gastrojejunostomy (SGJ) has been the standard treatment for malignant GOO and endoscopic stenting (ES) offers a less invasive option, but it often requires repeat interventions. Recently, endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE), an innovative technique, has been applied as an alternative to SGJ and ES for GOO patients. Direct EUS-GE, device-associated EUS-GE, and EUS-guided double balloon-occluded gastrojejunostomy bypass are the most commonly used techniques with reported technical success rates ranging from 80% to 100%, and clinical success rates between 68% and 100%. Adverse event (AE) rates range from 0% to 28.2% and the stent misdeployment is the most common while other AEs include abdominal pain, bleeding, infection, peritonitis, bowel perforation, gastric leakage, and stent migration. It is clear that EUS-GE may achieve a similar clinical success to SGJ with fewer AEs and a shorter hospital stay. Compared to ES, EUS-GE showed higher clinical success, fewer stent obstructions, and lower reintervention rates.
胃出口梗阻（GOO）是一种由良性或恶性疾病引起的胃或十二指肠机械性梗阻疾病。传统上，外科胃空肠吻合术（SGJ）一直是恶性GOO的标准治疗方法，而内镜支架置入术（ES）提供了一种侵入性较小的选择，但通常需要重复干预。最近，内镜超声（EUS）引导下胃肠造口术（EUS-GE）作为一种创新技术，已被应用于替代GOO患者的SGJ和ES。直接EUS-GE、器械相关EUS-GE和EUS引导下双气囊闭塞胃空肠吻合术旁路是最常用的技术，报道的技术成功率在80%至100%之间，临床成功率在68%至100%之间。不良事件（AE）发生率在0%至28.2%之间，支架部署不当是最常见的，而其他AE包括腹痛、出血、感染、腹膜炎、肠穿孔、胃漏和支架移位。显然，EUS-GE可以取得与SGJ相似的临床成功，不良事件更少，住院时间更短。与ES相比，EUS-GE显示出更高的临床成功率、更少的支架梗阻和更低的再次干预率。
