Background and Aims

EUS-guided gastroenterostomy (EUS-GE) has emerged as an option for managing malignant gastric outlet obstruction (GOO). However, there is currently no standardized technique, and outcomes are variable with inconsistencies both within and across centers. The present study aims to develop and assess outcomes of a Standardized Clinical and Assessment Management Plan (SCAMP) for EUS-GE.

Methods

A SCAMP was created by a multidisciplinary team to develop and optimize a systematic approach for EUS-GE. This is a single-center, prospective cohort study on patients undergoing EUS-GE for GOO, using the developed SCAMP. Baseline demographics, cancer diagnosis and stage, Eastern Cooperative Oncology Group (ECOG) performance score, clinical and technical success, adverse events (AEs), and obstruction recurrence were collected. Primary outcomes included technical and clinical success. Obstruction-free and overall survival were calculated and compared with Kaplan-Meier analysis.

Results

Fifty patients underwent EUS-GE in accordance with the SCAMP. Mean age was 67 years, 54% were women, and pancreatic cancer represented the largest cancer type (51%). Technical success was 100% and clinical success 92%. AEs occurred in 2 patients (4%). Recurrent obstruction occurred in 16%, related to distal small-bowel obstruction from carcinomatosis. Estimated mean obstruction-free survival was 217 days. Median overall survival was 230 days among patients with ECOG scores 0 to 2 and 82 days for ECOG scores ≥3 (P = .008).

Conclusions

The standardized technique used was associated with high technical and clinical success and low rates of AEs, morbidity and procedure-related mortality. Adopting a similar uniform systematic approach may improve procedural outcomes and dissemination.

中文翻译：

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优化 EUS 引导的胃肠造口术的结果：标准化临床评估和管理计划的结果（附视频）

背景和目标

EUS引导的胃肠造口术（EUS-GE）已成为治疗恶性胃出口梗阻（GOO）的一种选择。然而，目前还没有标准化的技术，并且结果因中心内部和中心之间的不一致而变化。本研究旨在为 EUS-GE 制定和评估标准化临床和评估管理计划 (SCAMP) 的结果。

方法

SCAMP 由一个多学科团队创建，旨在开发和优化 EUS-GE 的系统方法。这是一项使用开发的 SCAMP 对接受 EUS-GE 治疗 GOO 的患者进行的单中心前瞻性队列研究。收集基线人口统计学、癌症诊断和分期、东部肿瘤协作组 (ECOG) 性能评分、临床和技术成功、不良事件 (AE) 和梗阻复发。主要结果包括技术和临床成功。计算无梗阻和总生存期，并与 Kaplan-Meier 分析进行比较。

结果

50 名患者根据 SCAMP 接受了 EUS-GE。平均年龄为 67 岁，54% 为女性，胰腺癌是最大的癌症类型（51%）。技术成功率为 100%，临床成功率为 92%。2 名患者 (4%) 发生 AE。复发性梗阻发生率为 16%，与癌病引起的远端小肠梗阻有关。估计的平均无梗阻生存期为 217 天。ECOG 评分为 0 至 2 的患者中位总生存期为 230 天，ECOG 评分≥3 的患者为 82 天（P  = .008）。

结论

使用的标准化技术与较高的技术和临床成功率以及较低的 AE、发病率和手术相关死亡率相关。采用类似的统一系统方法可以改善程序结果和传播。