腸内ステントまたは内視超音波誘導胃腸静止術を用いた悪性胃口閉塞の緩和療法を受けた患者の全生存率
Akhil Mahajan1, Sridhar Sundaram1, Rahul Puri1
1Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Journal of gastroenterology and hepatology
|August 30, 2025
まとめ
腸内ステント (ES) と比較して,内視超音波誘導胃腸静止術 (EUS-GE) はよりよい臨床的成功と,悪性胃出口阻害に対する再介入を可能にします. EUS- GEで臨床的に成功した患者も生存期間が長かった.
科学分野:
- 胃腸内科
- 介入内視鏡検査
- 腫瘍学
背景:
- 悪性胃出口阻害 (mGOO) は緩和ケアにおける大きな課題です.
- mGOOの管理には,EUS-ガイデッド胃腸口術 (EUS-GE) や腸内ステント (ES) のような最小侵襲的内視鏡検査が不可欠です.
- EUS- GEとESの客観的な比較は,臨床意思決定を導くために必要である.
研究 の 目的:
- 悪性胃出口阻害 (mGOO) の患者で,EUS- 誘導胃腸口術 (EUS- GE) と腸内ステント (ES) の有効性を比較する.
- EUS- GEとESの臨床成功率,全生存率,再介入率を評価する.
- mGOOの緩和治療における患者の生存に臨床的成功が影響するかどうかを判断する.
主な方法:
- mGOOを2021年1月から2024年1月にかけて治療した172人の患者 (60 EUS- GE,112 ES) の遡及レビュー.
- 臨床的成功は,経口摂取と食事の一貫性における2ポイントの改善で,胃出口阻害スコアシステム (GOOSS) を用いた.
- 主要アウトカムには,臨床的成功と全生存期間;次要アウトカムには,有害事象,再介入率,再介入なしの生存期間が含まれていた.
主要な成果:
- 技術的な成功率はEUS-GE (95.08%) とES (99.09%) の間で比較可能であった.
- EUS- GEは,ES (77. 5%) に比べて,臨床成功率 (94. 7%) が著しく高かった.
- 再介入は,EUS- GEグループ (3. 3%) よりも頻繁に必要であったが,全生存率と再介入なしの生存率は,グループによって有意に異なっていなかった.
結論:
- EUS- 誘導胃腸静止術 (EUS- GE) は,よりよい臨床結果を達成し,mGOO緩和における再介入の必要性を減らすために,腸内ステント (ES) よりも優れています.
- EUS- GEで臨床的成功を収めた患者は,生存率の改善を示した.
- これらの発見は,悪性胃出口阻害の管理のための好ましい選択肢としてEUS- GEを支持します.
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