Endoscopic ultrasonography-guided gastroenterostomy: the end of the duodenal stent?
Menée entre 2020 et 2022 sur 97 patients souffrant d'une occlusion de l'orifice gastrique liée à une tumeur gastroduodénale ou pancréatobiliaire non résécable, cet essai randomisé international évalue l'efficacité, du point de vue de la nécessité de reprise chirurgicale à 6 mois, d'une gastro-entéro-anastomose guidée par écho-endoscopie par rapport à la pose d'une endoprothèse duodénale conventionnelle
Gastric outlet obstruction is a common complication of (advanced) gastric, duodenal, or pancreatobiliary cancer and leads to decreased quality of life. Traditionally, palliative treatment options for malignant gastric outlet obstruction consist of surgical gastroenterostomy or endoscopic duodenal stenting. In daily clinical practice, a duodenal stent is often placed because it provides rapid relief of symptoms with minimal invasiveness. However, after placement of a duodenal stent, reinterventions are frequently needed due to stent ingrowth or overgrowth. Over the past decade, therapeutic endoscopic ultrasonography (EUS) has developed rapidly. Consequently, EUS-guided gastroenterostomy (EUS-GE) now offers an alternative, minimally invasive treatment option for patients with malignant gastric outlet obstruction. Because the malignant obstruction is bypassed at a distance from the tumour, it is expected to avoid the risk of recurrent obstruction due to stent ingrowth. Several retrospective comparative studies have suggested that EUS-GE has similar technical success, superior clinical success, and a reduced need for reintervention compared with duodenal stenting. However, randomised controlled trials have been lacking.
The Lancet Gastroenterology & Hepatology , commentaire, 2022