目的:内镜超声引导下的胃肠造口术(EUS-GE)越来越多地用于无法手术的恶性胃出口梗阻(GOO)。然而,EUS-GE对患者生活质量(QoL)的影响尚未进行前瞻性评估.
方法:在基线和手术后1个月,使用欧洲癌症研究与治疗组织(EORTC)问卷EORTC-QLQ-C30对2019年8月至2021年5月在西班牙四个中心连续接受EUS-GE的不可切除的恶性GOO患者进行前瞻性评估。通过电话进行了集中的后续行动。胃出口梗阻评分系统(GOOSS)用于评估口服摄入量,将临床成功定义为GOOSS≥2。使用线性混合模型评估基线和30天QoL评分之间的差异。
结果:纳入64例患者,男性33人(51.6%),平均年龄77.3岁(IQR:65.5-86.5岁)。最常见的诊断是胰腺(35.9%)和胃(31.3%)腺癌。37例(57.9%)患者的基线ECOG表现状况评分为2/3。61例(95.3%)患者在48小时内重新开始口服摄入,中位术后住院时间为3.5天(IQR:2-5天)。30天临床成功率为83.3%。在全球健康状况量表中,临床上显着增加了21.6(95%CI:11.5-31.7)点,随着恶心/呕吐的显著改善,疼痛,便秘和食欲不振。
结论:EUS-GE已被证明可以缓解不可切除恶性肿瘤患者的GOO症状,允许快速口服和出院。它还提供了从基线开始30天的QoL评分的临床相关增加。
EUS-guided gastroenterostomy (EUS-GE) is increasingly used for malignant gastric outlet obstruction (GOO) in inoperable patients. However, the impact of EUS-GE on patient quality of life (QoL) has not been evaluated prospectively.
Consecutive patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at 4 Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 at baseline and 1 month after the procedure. Centralized follow-up by telephone calls was undertaken. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS ≥2. Differences between baseline and 30-day QoL scores were assessed using a linear mixed model.
Sixty-four patients were enrolled, 33 (51.6%) men, with a median age of 77.3 years (interquartile range, 65.5-86.5). The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven patients (57.9%) presented a 2/3 baseline Eastern Cooperative Oncology Group performance status score. Oral intake was restarted within 48 hours in 61 patients (95.3%), and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale was documented, with significant improvements in nausea and vomiting, pain, constipation, and appetite loss.
EUS-GE relieves GOO symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in QoL scores at 30 days from baseline. (Clinical trial registration number: NCT04660695.).