Muhammad Asghar, David Forcione, Srinivas Reddy Puli
{"title":"内镜超声引导下胃肠造口术与肠道支架术治疗胃出口梗阻：系统综述和荟萃分析。","authors":"Muhammad Asghar, David Forcione, Srinivas Reddy Puli","doi":"10.1177/17562848241248219","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES.</p><p><strong>Design: </strong>Meta-analysis and systematic review.</p><p><strong>Data sources and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>I</i> <sup>2</sup> = 32] and 97.96% (95% CI, 96.06-99.25, <i>I</i> <sup>2</sup> = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, <i>I</i> <sup>2</sup> = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, <i>I</i> <sup>2</sup> = 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, <i>I</i> <sup>2</sup> = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, <i>I</i> <sup>2</sup> = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, <i>I</i> <sup>2</sup> = 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, <i>I</i> <sup>2</sup> = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, <i>I</i> <sup>2</sup> = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, <i>I</i> <sup>2</sup> = 89).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":3,"journal":{"name":"ACS Applied Electronic Materials","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11159541/pdf/","citationCount":"0","resultStr":"{\"title\":\"Endoscopic ultrasound-guided gastroenterostomy <i>versus</i> enteral stenting for gastric outlet obstruction: a systematic review and meta-analysis.\",\"authors\":\"Muhammad Asghar, David Forcione, Srinivas Reddy Puli\",\"doi\":\"10.1177/17562848241248219\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES.</p><p><strong>Design: </strong>Meta-analysis and systematic review.</p><p><strong>Data sources and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>I</i> <sup>2</sup> = 32] and 97.96% (95% CI, 96.06-99.25, <i>I</i> <sup>2</sup> = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, <i>I</i> <sup>2</sup> = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, <i>I</i> <sup>2</sup> = 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, <i>I</i> <sup>2</sup> = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, <i>I</i> <sup>2</sup> = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, <i>I</i> <sup>2</sup> = 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, <i>I</i> <sup>2</sup> = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, <i>I</i> <sup>2</sup> = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, <i>I</i> <sup>2</sup> = 89).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":3,\"journal\":{\"name\":\"ACS Applied Electronic Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-06-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11159541/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Electronic Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17562848241248219\",\"RegionNum\":3,\"RegionCategory\":\"材料科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"ENGINEERING, ELECTRICAL & ELECTRONIC\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Electronic Materials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562848241248219","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"ENGINEERING, ELECTRICAL & ELECTRONIC","Score":null,"Total":0}
引用次数: 0
摘要
背景：传统上，胃出口梗阻的症状可通过手术或内镜进行治疗。胃肠道支架植入术（ES）是一种创伤较小的内镜治疗方法。最近，内镜超声引导胃肠造口术（EUS-GE）已成为一种潜在的替代技术：我们对 EUS-GE 与 ES 相比的有效性和安全性进行了系统回顾和荟萃分析：荟萃分析和系统综述：我们检索了从开始到 2023 年 8 月的多个数据库，以确定报道 EUS-GE 与 ES 相比的有效性和安全性的研究。对技术成功率、临床成功率和不良事件（AEs）等结果进行了评估。采用固定效应和随机效应模型计算汇总比例：我们在最终分析中纳入了 13 项研究，共 1762 名患者。EUS-GE 的汇总技术成功率为 95.59% [95% 置信区间 (CI)，94.01-97.44，I 2 = 32]，ES 为 97.96%（95% CI，96.06-99.25，I 2 = 63）。EUS-GE 的汇总临床成功率为 93.62%（95% CI，90.76-95.98，I 2 = 54），而 ES 的临床成功率较低，为 85.57%（95% CI，79.63-90.63，I 2 = 81）。与 ES 相比，EUS-GE 临床成功的汇总赔率（OR）更高，为 2.71（95% CI，1.87-3.93）。与 ES 相比，EUS-GE 临床成功的汇总 OR 为 2.72（95% CI，1.86-3.97，I 2 = 0）。EUS-GE 的再干预率为 3.77%（95% CI，1.77-6.46，I 2 = 44），低于 ES 的 25.13%（95% CI，18.96-31.85，I 2 = 69）。ES 组再次干预率的汇总 OR 值较高，为 7.96（95% CI，4.41-14.38，I 2 = 13）。总体而言，EUS-GE的AEs汇总率为8.97%（95% CI，6.88-11.30，I 2 = 15），而ES的AEs汇总率为19.63%（95% CI，11.75-28.94，I 2 = 89）：结论：就技术效果而言，EUS-GE 和 ES 具有可比性。结论：就技术效果而言，EUS-GE 和 ES 具有可比性，但在缓解胃出口梗阻方面，EUS-GE 的临床效果更好，再次介入治疗的需求更低，安全性也优于 ES。
Endoscopic ultrasound-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: a systematic review and meta-analysis.
Background: 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.
Objectives: We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES.
Design: Meta-analysis and systematic review.
Data sources and methods: 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.
Results: 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, I2 = 32] and 97.96% (95% CI, 96.06-99.25, I2 = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, I2 = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, I2 = 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, I2 = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, I2 = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, I2 = 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, I2 = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, I2 = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, I2 = 89).
Conclusion: 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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
