EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video)

医学 胃肠造口术 胃出口梗阻 支架 恶性肿瘤 危险系数 自膨胀金属支架 回顾性队列研究 外科 覆膜支架 姑息治疗 癌症 内科学 胃切除术 置信区间
作者
Rubén Sánchez-Aldehuelo,José Carlos Subtil Iñigo,Belén Martínez‐Moreno,Joan B. Gornals,Carlos Guarner–Argente,Alejandro Repiso Ortega,Sandra Peralta Herce,José Ramón Aparicio,Enrique Rodríguez de Santiago,Sergio Bazaga,Diego Juzgado,Fernando González-Panizo,Agustı́n Albillos,Enrique Vázquez-Sequeiros
出处
期刊:Gastrointestinal Endoscopy [Elsevier BV]
卷期号:96 (6): 1012-1020.e3 被引量:24
标识
DOI:10.1016/j.gie.2022.07.018
摘要

Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO) has been surgical, but surgical treatment carries significant morbidity and mortality rates. Endoscopic placement of a duodenal self-expandable metal stent (D-SEMS) has been proven to be successful for this indication in the short term. However, D-SEMSs are likely to malfunction over time. EUS-guided gastroenterostomy (EUS-GE) may help overcome these limitations. We aimed to evaluate stent failure-free survival at 3 months.A nationwide multicenter, observational study of D-SEMS and EUS-GE procedures for patients with malignant GOO was conducted at 7 academic centers from January 2015 to June 2020. Stent failure-free survival at 1, 3, and 6 months; technical and clinical success; adverse events (AEs); and patient survival were evaluated in both groups and compared.Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group. Pancreatic cancer was the main underlying malignancy in 53.4%. No statistically significant differences regarding technical (92.8% vs 93.7%) or clinical success (83.5% vs 92.4%) were found. AE rates did not differ between groups (10.3% vs 10.1%), although 2 events in the EUS-GE group required surgical management. Patients in the EUS-GE group had improved stent patency when compared with those patients in the D-SEMS group at 3 months (92.23% vs 80.6%; adjusted hazard ratio, .37; P = .033).EUS-GE seems to have improved patency outcomes when compared with D-SEMS placement for palliative treatment of malignant GOO. Prospective trials are needed to fully compare their efficacy and AE profile.
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