Abstract:

Value of endoscopic technique in treating malignant gastric outlet obstruction caused by advanced gastric cancer        CHEN Wei-feng，XU Jia-xin.  Endoscopy Center，Zhongshan Hospital，Fudan University，Shanghai 200032，China
Corresponding author：CHEN Wei-feng，E-mail：chen.weifeng@zs-hospital.sh.cn
Abstract    Malignant gastric outlet obstruction (MGOO) is common in patients with gastric cancer. MGOO is generally associated with poor prognosis and debilitating symptoms including intractable nausea，vomiting and dysphagia，which may cause electrolyte disorders and malnutrition，and suspend the coming chemoradiotherapy. The main goal for the patients is to palliate the symptoms by reinstituting luminal patency. Given to its noninvasive，associated high technical and clinical success，low adverse event rate，and potential shorter time to per oral intake，the endoscopic placement of stents has led to widespread application. However，it still has a high rate of stent obstruction and migration，which needs reinterventions. Ultrasound endoscope guided gastroenterostomy is a novel and promising concept that can provide sustained palliation with minimally invasive approach，because of the similar bypass to surgical treatment. It is recommended that individualized therapy should be selected by the comprehensive evaluation of the tumor characteristics，life expectancy，combination with the skills of the endoscopist.

Key words: malignant gastric outlet obstruction, endoscopic placement of stents, ultrasound endoscope guided gastroenterostomy

摘要：

恶性胃流出道梗阻是晚期胃癌常见的并发症之一，严重影响病人生存质量，梗阻引起的恶心、呕吐及进食困难等常导致病人电解质紊乱和营养失衡，阻碍后续放化疗进程，甚至直接加速病人死亡。对于此类病人，减轻梗阻是治疗的首要目标。内镜下支架置入术因其微创、成功率高、疗效确切、并发症发生率低、缩短进食时间等优势，目前已被广泛用于治疗发生梗阻的晚期胃癌病人；但由于远期支架阻塞、移位等不良事件的发生，往往需要二次治疗。超声内镜引导下胃肠吻合术与外科旁路手术类似进行消化道改道，兼具创伤小、长期疗效稳定的特点，前景广阔。应结合病人肿瘤特点、预期生存时间、术者操作能力，选择合适的治疗手段。

关键词: 恶性胃流出道梗阻, 内镜下支架置入术, 超声内镜引导下胃肠吻合