EUS-guided gastroenterostomy: the first US clinical experience (with video)
EUS-guided gastroenterostomy: the first US clinical experience (with video)
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DOI：
10.1016/j.gie.2015.06.017
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发表时间：
2015-11-01
影响因子：
7.7
通讯作者：
Baron, Todd H.
中科院分区：
文献类型：
--
作者：
Khashab, Mouen A.;Kumbhari, Vivek;Baron, Todd H.
背景和目的：肠内自膨式金属支架和胃空肠吻合术治疗胃出口梗阻（GOO）患者存在局限性。 EUS引导的胃肠造口术（EUS-GE）是一种新颖的手术，可以提供持久的管腔通畅性，而没有肿瘤向内生长和/或过度生长的风险，同时避免了外科手术的发病率。本研究的目的是报告美国首次 EUS-GE 的技术成功、临床成功和不良事件方面的临床经验，并详细说明进行 EUS-GE 的技术方面。 方法：这是来自两个三级护理中心的回顾性研究。 EUS-GE 通过使用直接 EUS-GE 或球囊辅助 EUS-GE 技术进行。技术成功被定义为通过内窥镜和放射学确定的支架的充分定位和部署。临床成功的定义是患者能够耐受经口摄入而不呕吐。结果：共有 10 名患者尝试接受 EUS-GE。 3 名患者出现恶性 GOO，而其余 7 名患者则发现良性梗阻。一名患者患有完全 GOO，并成功接受了直接 EUS-GE。在其余 9 名患者中，尝试了球囊辅助 EUS-GE，其中 8 名患者取得了成功。因此，9 名患者 (90%) 取得了技术成功。没有发生与手术相关的不良事件。平均手术时间为 96 分钟（范围 45-152 分钟），平均住院时间为 2.2 天。成功接受 EUS-GE 的所有 9 名患者 (100%) 均取得了恢复固体口服摄入的临床成功。总共8名患者能够耐受几乎正常饮食和/或全饮食，1名患者能够耐受软饮食。平均随访150天，无症状复发。结论：EUS-GE是治疗良性和恶性GOO症状的一种有前途的新技术。需要进行前瞻性多中心试验来证实这些结果。
Background and Aims: There are limitations to enteral self-expandable metal stents and surgical gastrojejunostomy in the treatment of patients with gastric outlet obstruction (GOO). EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth and/or overgrowth, while avoiding the morbidity of a surgical procedure. The aims of this study were to report the first U.S. clinical experience with EUS-GE in terms of technical success, clinical success, and adverse events and to detail the technical aspects of performing EUS-GE.Methods: This was a retrospective study from two tertiary-care centers. EUS-GE was performed by using either the direct EUS-GE or balloon-assisted EUS-GE technique. Technical success was defined as adequate positioning and deployment of the stent as determined endoscopically and radiologically. Clinical success was defined as the patient's ability to tolerate oral intake without vomiting.Results: A total of 10 patients underwent attempted EUS-GE. Malignant GOO was present in 3 patients, whereas benign obstruction was found in the remaining 7. One patient had complete GOO and underwent successful direct EUS-GE. In the remaining 9 patients, balloon-assisted EUS-GE was attempted and was successful in 8. Thus, technical success occurred in 9 patients (90%). There were no procedure-related adverse events. Mean procedure time was 96 minutes (range 45-152 minutes), and mean length of hospital stay was 2.2 days. Clinical success with resumption of solid oral intake was achieved in all 9 patients (100%) who underwent successful EUS-GE. A total of 8 patients were able to tolerate almost a normal diet and/or full diet, and 1 patient tolerated a soft diet. There was no symptom recurrence during a mean follow-up period of 150 days.Conclusions: EUS-GE is a promising new technique for the treatment of symptoms of benign and malignant GOO. Prospective, multicenter trials are needed to confirm these results.