文章：

胆道梗阻合并胃出口梗阻的姑息治疗——一项回顾性多中心研究：B-GOOD研究

Palliation of Gastric Outlet Obstruction in Case of Biliary Obstruction—A Retrospective, Multicenter Study: The B-GOOD Study

原文发布日期：2 October 2024

DOI: 10.3390/cancers16193375

类型: Article

开放获取: 是

英文摘要：

Background: EUS-guided gastroenterostomy (EUS-GE) is a novel and effective procedure for the management of malignant gastric outlet obstruction (GOO) with more durable results when compared to enteral stenting (ES). However, data comparing EUS-GE to ES in patients already treated with EUS-guided choledocoduodenostomy (EUS-CDS) for distal malignant biliary obstruction (DMBO) are lacking. We aimed to compare outcomes of EUS-GE and ES for the palliation of GOO in this specific population of patients. Methods: A multicenter, retrospective analysis of patients with DMBO treated by EUS-CDS and subsequent GOO treated by EUS-GE or ES from 2016 to 2021 was conducted. Primary outcomes were overall AEs rate and dysfunction of the EUS-CDS after GOO treatment. Secondary outcomes included clinical success, technical success, procedure duration, length of hospital stay and relapse of GOO symptoms. Results: A total of 77 consecutive patients were included in the study: 25 patients underwent EUS-GE and 52 underwent ES. AEs rate and patency outcomes of the EUS-CDS after GOO treatment were comparable between the two groups (12.5% vs. 17.3%;p= 0.74). No recurrence of GOO symptoms was registered in the EUS-GE group while 11.5% of ES patients had symptoms recurrence, even if not statistically significant (p= 0.16), after a mean follow-up period of 63.5 days. Conclusion: EUS-GE and ES are both effective and safe for the palliation of GOO in patients already treated by EUS-CDS for DMBO with no difference in the biliary stent dysfunction rate and overall AEs. EUS-GE is associated with less recurrence of GOO symptoms.

摘要翻译： 

背景：超声内镜引导下胃肠吻合术（EUS-GE）是一种治疗恶性胃流出道梗阻（GOO）的新型有效方法，与肠道支架置入术（ES）相比，其疗效更为持久。然而，目前尚缺乏针对已接受超声内镜引导下胆总管十二指肠吻合术（EUS-CDS）治疗远端恶性胆道梗阻（DMBO）的患者，比较EUS-GE与ES疗效的数据。本研究旨在比较EUS-GE与ES在这一特定患者群体中缓解GOO的临床结局。 方法：本研究对2016年至2021年间接受EUS-CDS治疗DMBO，随后因GOO接受EUS-GE或ES治疗的患者进行了多中心回顾性分析。主要结局指标为总体不良事件发生率以及GOO治疗后EUS-CDS的功能障碍情况。次要结局指标包括临床成功率、技术成功率、手术时长、住院时间以及GOO症状复发情况。 结果：研究共纳入77例连续患者：其中25例接受EUS-GE治疗，52例接受ES治疗。两组患者在GOO治疗后EUS-CDS的不良事件发生率和通畅性结局方面具有可比性（12.5% vs. 17.3%；p=0.74）。在平均63.5天的随访期内，EUS-GE组未出现GOO症状复发，而ES组有11.5%的患者出现症状复发，尽管差异无统计学意义（p=0.16）。 结论：对于已接受EUS-CDS治疗DMBO的患者，EUS-GE和ES在缓解GOO方面均安全有效，且在胆道支架功能障碍率和总体不良事件方面无显著差异。EUS-GE与较低的GOO症状复发率相关。

原文链接：

Palliation of Gastric Outlet Obstruction in Case of Biliary Obstruction—A Retrospective, Multicenter Study: The B-GOOD Study