A142 ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY: A CASE SERIES AND REVIEW OF LITERATURE
Notice bibliographique
Résumé
Abstract Background Gastric outlet obstruction (GOO) refers to the clinical syndrome of epigastric pain and postprandial vomiting due to mechanical obstruction in the distal stomach or proximal duodenum. Management is undertaken to alleviate symptoms with the aim of maintaining nutritional status and improving quality of life. Endoscopic gastroduodenal stenting and surgical gastroenterostomy (SGE) are two established methods in the management of GOO. Enteral stenting is associated with stent malfunction such as migration and obstruction often requiring reintervention; SGE is associated with a higher degree of morbidity and mortality compared to endoscopic approaches. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE), with the placement of a lumen-apposing metallic stents (LAMS) from the stomach to the small bowel distal to the obstruction, has emerged as an alternative approach in the management of GOO. Aims To describes a case series of patients who underwent EUS-GE and review the relevant literature. Methods This was a single-centre retrospective case series of 9 patients with GOO who underwent EUS-GE at Vancouver General Hospital. We looked at technical success, clinical success, and adverse outcomes. Technical success was defined as ability to place a LAMS between the stomach and the small bowel. Clinical success was defined as the patient’s ability to tolerate oral intake. Results A total of 9 patients with GOO underwent EUS-GE. The median age was 65. 5 were females (55%) and 4 (45%) were males. GOO was due to malignant tumors or metastases in 8 cases (89%) and in one case was due to afferent limb syndrome after pancreaticoduodenectomy. The technical and clinical success rate was 100%. The stents had a diameter of 15 mm in 7 cases (77%). The stents had a saddle length of 10mm in 7 cases (77%). All cases were performed under general anesthesia. There were no adverse outcomes. The median time to discharge was 8 days. At the time of the study, 5 patients had deceased, with a mean survival of 17 weeks. We identified two systematic reviews and meta-analyses looking at EUS-GE. The majority of data comes from retrospective studies. They assessed 285 and 260 patients. Technical success was achieved in 92-93.5% of cases, clinical success was achieved in 90% across both studies, adverse outcomes occurred in 12% of cases in both studies. Conclusions EUS-GE is an alternative endoscopic approach in the management of GOO with the ability to ameliorate symptoms of GOO and improve quality of life. It is less invasive than SGE and provides a more durable approach compared to endoscopic stenting. We describe a series of patients at VGH who underwent EUS-GE with a technical and clinical success rate similar to that described in the literature. Further randomized studies comparing the different modalities of treatment for GOO are needed. Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,007 | 0,007 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».