EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction
| Autor: | Ahmad S. Alawad, Yamile Haito-Chavez, Saowanee Ngamruenphong, Amr Ismail, Yen I. Chen, Vivek Kumbhari, Ian S. Grimm, Gulara Hajiyeva, Mouen A. Khashab, Takao Itoi, Majidah Bukhari, Jose Nieto, Todd H. Baron |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Endoscopic ultrasound
Adult Male Reoperation medicine.medical_specialty medicine.medical_treatment Digestive System Neoplasms Enteral administration Endosonography 03 medical and health sciences 0302 clinical medicine Gastroscopy medicine Humans Ultrasonography Interventional Aged Retrospective Studies medicine.diagnostic_test business.industry Gastric Outlet Obstruction Palliative Care Stent Gastric outlet obstruction Retrospective cohort study Middle Aged Gastroenterostomy medicine.disease digestive system diseases Surgery Treatment Outcome 030220 oncology & carcinogenesis Vomiting 030211 gastroenterology & hepatology Female Stents medicine.symptom business Abdominal surgery Follow-Up Studies |
| Zdroj: | Surgical endoscopy. 31(7) |
| ISSN: | 1432-2218 |
| Popis: | Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs). Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010. A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES (p = 0.2) and 83.3% EUS-GE versus 67.3% ES (p = 0.12), respectively. Symptom recurrence and need for re-intervention, however, was significantly lower in the EUS-GE group (4.0 vs. 28.6%, (p = 0.015). Post-procedure mean length of hospitalization was comparable at 11.3 days ± 6.6 for EUS-GE versus 9.5 days ± 8.3 for ES (p = 0.3). Rates and severity of AEs (as per the ASGE lexicon) were also similar (16.7 vs. 11.5%, p = 0.5). On multivariable analysis, ES was independently associated with need for re-intervention (OR 12.8, p = 0.027). EUS-GE may be ideal for malignant GOO with comparable effectiveness and safety to ES while being associated with fewer symptom recurrence and requirements for re-intervention. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink