Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video)

被引:80
作者
Bronswijk, Michiel [1 ,2 ]
Vanella, Giuseppe [3 ]
Van Malenstein, Hannah [1 ]
Laleman, Wim [1 ]
Jaekers, Joris [4 ]
Topal, Baki [4 ]
Daams, Freek [5 ]
Besselink, Marc G. [6 ]
Arcidiacono, Paolo Giorgio [3 ]
Voermans, Rogier P. [7 ,8 ]
Fockens, Paul [9 ]
Larghi, Alberto [10 ,11 ,12 ]
van Wanrooij, Roy L. J. [9 ]
Van der Merwe, Schalk W. [1 ]
机构
[1] Univ Leuven, Univ Hosp Gasthuisberg, Dept Gastroenterol & Hepatol, Herestr 49, B-3000 Leuven, Belgium
[2] Imelda Gen Hosp, Dept Gastroenterol & Hepatol, Bonheiden, Belgium
[3] IRCCS San Raffaele Sci Inst, Pancreatobiliary Endoscopy & Endosonog Div, Milan, Italy
[4] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Visceral Surg, Leuven, Belgium
[5] Vrije Univ, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
[6] Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
[7] Canc Ctr Amsterdam, Amsterdam, Netherlands
[8] Univ Amsterdam, Dept Gastroenterol & Hepatol, Amsterdam UMC, Amsterdam, Netherlands
[9] Vrije Univ, Dept Gastroenterol & Hepatol, Amsterdam UMC, Amsterdam, Netherlands
[10] AGEM Inst, Amsterdam, Netherlands
[11] Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Digest Endoscopy Unit, Rome, Italy
[12] Catholic Univ, CERTT, Ctr Endoscop Res Therapeut & Training, Rome, Italy
关键词
CLINICAL-EXPERIENCE; GASTROJEJUNOSTOMY; BYPASS; STENT;
D O I
10.1016/j.gie.2021.04.006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: In the management of gastric outlet obstruction (GOO), EUS-guided gastroenterostomy (EUS-GE) seems to be safe and more effective than enteral stent placement. However, comparisons with laparoscopic GE (L-GE) are scarce. Our aim was to perform a propensity score-matched comparison between EUS-GE and L-GE. Methods: An international, multicenter, retrospective analysis was performed of consecutive EUS-GE and L-GE procedures in 3 academic centers (January 2015 to May 2020) using propensity score matching to minimize selection bias. A standard maximum propensity score difference of .1 was applied, also considering underlying disease and oncologic staging. Results: Overall, 77 patients were treated with EUS-GE and 48 patients with L-GE. By means of propensity score matching, 37 patients were allocated to both groups, resulting in 74 (1:1) matched patients. Technical success was achieved in 35 of 37 EUS-GE-treated patients (94.6%) versus 100% in the L-GE group (P = .493). Clinical success, defined as eating without vomiting or GOO Scoring System >= 2, was achieved in 97.1% and 89.2%, respectively (P=.358). Median time to oral intake (1 [interquartile range {IQR}, .3-1.0] vs 3 [IQR, 1.0-5.0] days, P<.001) and median hospital stay (4 [IQR, 2-8] vs 8 [IQR, 5.5-20] days, P<.001) were significantly shorter in the EUS-GE group. Overall (2.7% vs 27.0%, P = .007) and severe (.0% vs 16.2%, P = .025) adverse events were identified more frequently in the L-GE group. Conclusions: For patients with GOO, EUS-GE and L-GE showed almost identical technical and clinical success. However, reduced time to oral intake, shorter median hospital stay, and lower rate of adverse events suggest that the EUS-guided approach might be preferable.
引用
收藏
页码:526 / +
页数:13
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