超声内镜引导胃肠吻合术直接法和双气囊封堵法治疗胃流出道梗阻疗效对比的回顾性队列研究（含视频）

Efficacy of direct versus double‑balloon occlusion techniques in endoscopic ultrasound‑guided gastroenterostomy for gastric outlet obstruction: a retrospective cohort study (with video)

摘要:

目的 比较直接法和双气囊封堵法两种术式在超声内镜引导胃肠吻合术（endoscopic ultrasound‑guided gastroenterostomy，EUS‑GE）治疗良恶性胃流出道梗阻（gastric outlet obstruction，GOO）中的临床疗效。方法 对2017年4月至2024年7月在南京鼓楼医院接受EUS‑GE治疗的GOO患者资料进行回顾性队列研究。根据手术方式不同分为直接法组和双气囊封堵法组。比较两组在技术成功率、临床成功率、手术时间、术后住院时间、后期支架更换率、不良事件发生率等方面的差异。结果 共纳入141例GOO患者，其中直接法组36例，双气囊封堵法组105例。直接法组与双气囊封堵法组技术成功率分别为97.2%（35/36）和94.3%（99/105），差异无统计学意义（χ2=0.065，P=0.798）。两组临床成功率分别为94.4%（34/36）和86.7%（91/105），差异同样无统计学意义（χ2=0.932，P=0.334）。另外，直接法组在手术完成时间及术后住院时间上均短于双气囊封堵法组［33.4（23.2，42.3）min比43.4（31.7，63.1）min，Z=-3.057，P=0.002；4.0（3.00，5.75）d比6.0（5.00，9.00）d，Z=-4.031，P<0.001］。直接法组内镜相关不良事件发生率为11.1%（4/36），后期支架更换率为5.6%（2/36）；双气囊封堵法组不良事件发生率为11.4%（12/105），后期支架更换率为9.5%（10/105），组间差异无统计学意义（χ2<0.001，P=1.000；χ2=0.152，P=0.696）。结论 在EUS‑GE治疗GOO中，直接法和双气囊封堵法的疗效及安全性无差异，直接法在手术时间及术后住院时间上较双气囊封堵法具有优势。

Abstract:

Objective To compare the clinical efficacy of direct versus double‑balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS‑GE) for benign and malignant gastric outlet obstruction (GOO). Methods Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group (n=36) and the double-balloon occlusion technique group (n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) (χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) (χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.