文章：

内镜超声引导下胃肠吻合术与肠内支架置入术治疗恶性胃出口梗阻：一项回顾性倾向评分匹配研究

Endoscopic Ultrasound-Guided Gastroenterostomy versus Enteral Stenting for Malignant Gastric Outlet Obstruction: A Retrospective Propensity Score-Matched Study

原文发布日期：8 February 2024

DOI: 10.3390/cancers16040724

类型: Article

开放获取: 是

英文摘要：

Background: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen apposing metal stent has emerged as a minimally invasive treatment for the management of malignant gastric outlet obstruction (mGOO). We aimed to compare EUS-GE with enteral stenting (ES) for the treatment of mGOO. Methods: Patients who underwent EUS-GE or ES for mGOO between June 2017 and June 2023 at two Italian centers were retrospectively identified. The primary outcome was stent dysfunction. Secondary outcomes included technical success, clinical failure, safety, and hospital length of stay. A propensity score-matching analysis was performed using multiple covariates. Results: Overall, 198 patients were included (66 EUS-GE and 132 ES). The stent dysfunction rate was 3.1% and 16.9% following EUS-GE and ES, respectively (p= 0.004). Using propensity score-matching, 45 patients were allocated to each group. The technical success rate was 100% for both groups. Stent dysfunction was higher in the ES group compared with the EUS-GE group (20% versus 4.4%, respectively;p= 0.022) without differences in clinical efficacy (p= 0.266) and safety (p= 0.085). A significantly shorter hospital stay was associated with EUS-GE compared with ES (7.5 ± 4.9 days vs. 12.5 ± 13.0 days, respectively;p= 0.018). Kaplan–Meier analyses confirmed a higher stent dysfunction-free survival rate after EUS-GE compared with ES (log-rank test;p= 0.05). Conclusion: EUS-GE offers lower rates of stent dysfunction, longer stent patency, and shorter hospital stay compared with ES.

摘要翻译： 

背景：采用管腔对合金属支架的内镜超声引导下胃肠吻合术（EUS-GE）已成为治疗恶性胃流出道梗阻（mGOO）的微创疗法。本研究旨在比较EUS-GE与肠道支架置入术（ES）治疗mGOO的效果。方法：回顾性纳入2017年6月至2023年6月在意大利两家医疗中心接受EUS-GE或ES治疗的mGOO患者。主要观察指标为支架功能障碍发生率，次要指标包括技术成功率、临床失败率、安全性及住院时长。采用多变量进行倾向性评分匹配分析。结果：共纳入198例患者（EUS-GE组66例，ES组132例）。EUS-GE组与ES组的支架功能障碍发生率分别为3.1%和16.9%（p=0.004）。经倾向性评分匹配后，两组各纳入45例患者。两组技术成功率均为100%。ES组支架功能障碍发生率显著高于EUS-GE组（20%对4.4%，p=0.022），而临床疗效（p=0.266）与安全性（p=0.085）无统计学差异。EUS-GE组住院时长显著短于ES组（7.5±4.9天对12.5±13.0天，p=0.018）。Kaplan-Meier分析证实EUS-GE组无支架功能障碍生存率更高（时序检验p=0.05）。结论：与ES相比，EUS-GE具有更低的支架功能障碍率、更长的支架通畅时间及更短的住院时长。

原文链接：

Endoscopic Ultrasound-Guided Gastroenterostomy versus Enteral Stenting for Malignant Gastric Outlet Obstruction: A Retrospective Propensity Score-Matched Study