内镜超声引导下胃肠造口术治疗恶性胃出口梗阻：临床和人口学因素对结果的影响。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-03-01 DOI:10.1016/j.gie.2024.10.053

Ravi Teja Pasam MBBS, MPH , Thomas Mathews MD , Kimberly F. Schuster BA , Daniel Szvarca MD , Trent Walradt MD , Pichamol Jirapinyo MD, MPH , Christopher C. Thompson MD, MSc

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引用次数: 0

摘要

背景和目的：内镜超声引导下胃肠造口术（EUS-GE）已成为手术胃空肠造口术和腔内支架治疗恶性胃出口梗阻（MGOO）的替代方法。有关 EUS-GE 效果相关因素的研究十分有限：本中心对2016年1月至2023年11月期间接受EUS-GE治疗恶性胃出口梗阻的连续患者进行了回顾性观察研究。主要结果为技术成功（建立 EUS-GE）和临床成功（90 天随访时可耐受低残留饮食，无需再次干预）。次要结果为不良事件（AE）、再次干预和完全耐受常规饮食：技术成功率和临床成功率分别为92.70%（127/137）和88.00%，42.86%的患者可以耐受常规饮食。腹膜癌患者的技术成功率较低（OR：0.19，95% CI：0.04-0.93）。与十二指肠阻塞相比，胃部阻塞的临床成功几率较低（OR：0.06，95% CI：0.006-0.56）。AE和再介入率分别为14.17%和8.66%。在多变量分析中，在 EUS-GE 之前进行 NGT 减压与较低的 AE 发生率相关（OR：0.32，95% CI：0.11-0.95）。在多变量分析中，之前的胃肠道手术与再介入相关（OR：4.09；95% CI：1.02-16.45，P值：0.047）：EUS-GE的技术和临床成功率都很高，许多患者都能接受常规饮食。应考虑对 NGT 进行常规减压，以尽量减少 AEs。胃水平的 MGOO 与较低的临床成功率有关。对腹膜癌患者进行 EUS-GE 时应格外小心。之前的胃肠道手术很可能是再次介入的风险因素。

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EUS-guided gastroenterostomy for malignant gastric outlet obstruction: impact of clinical and demographic factors on outcomes

Background and Aims

EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to surgical gastrojejunostomy and endoluminal stenting for malignant gastric outlet obstruction (MGOO). Studies regarding factors associated with the EUS-GE outcomes are limited.

Methods

A retrospective observational study was conducted with consecutive patients who underwent EUS-GE for MGOO from January 2016 to November 2023. Primary outcomes were technical success (establishing EUS-GE) and clinical success (low-residue diet tolerance without re-intervention at 90-day follow-up). Secondary outcomes were adverse events (AEs), reinterventions, and full regular diet tolerance.

Results

Technical success and clinical success rates were 92.70% (127 of 137) and 88.00%, respectively, with 42.86% of the patients tolerating a regular diet. Patients with peritoneal carcinomatosis had lower odds of technical success (odds ratio [OR], .19; 95% confidence interval [CI], .04-.93). Obstruction at the level of stomach, compared with duodenum, had lower odds of clinical success (OR, .06; 95% CI, .006-.56). AE and reintervention rates were 14.17% and 8.66%. Nasogastric tube decompression before EUS-GE was associated with lower AE rates in multivariable analysis (OR, .32; 95% CI, .11-.95). Prior GI surgery was associated with reintervention in multivariable analysis (OR, 4.09; 95% CI, 1.02-16.45; P = .047).

Conclusions

EUS-GE has high technical and clinical success rates, with many patients tolerating a regular diet. Routine nasogastric tube decompression should be considered to minimize AEs. MGOO at the level of the stomach is associated with lower clinical success rates. Extra care should be taken while performing EUS-GE in patients with peritoneal carcinomatosis. Prior GI surgery is a likely risk factor for reintervention.

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.