Endoscopic Intervention for Anastomotic Leakage After Gastrectomy.

IF 3.2 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastric Cancer Pub Date : 2024-01-01 DOI:10.5230/jgc.2024.24.e12
Ji Yoon Kim, Hyunsoo Chung
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Abstract

Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.

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胃切除术后吻合口渗漏的内窥镜介入治疗。
吻合口漏和瘘是胃部手术的重要并发症,可能导致术后发病率和死亡率上升。手术治疗仅限于症状严重或血流动力学不稳定的病例,但手术并发症的风险较高。随着内镜治疗方法的进步,内镜方法已成为控制这些并发症的主要选择。内镜下夹持术是一种传统方法,主要包括两大类:镜下夹持术和镜上夹持术。镜下夹使用方便,可适应各种临床情况,而镜上夹则可缝合较大的缺损。另一种很有前景的方法是内窥镜支架植入,这种方法的漏孔闭合成功率很高,但需要严密监测支架的移位情况。手术后渗漏病例的感染控制至关重要,内窥镜内引流提供了一种相对安全和无创的液体管理方法,有助于感染控制和促进伤口愈合。内窥镜缝合可实现全厚伤口闭合,但需要额外的培训和内窥镜的多功能性。作为一种很有前途的工具,内窥镜真空疗法通过排出炎性物质和闭合缺损,有可能超越支架疗法。此外,据报道,在特定情况下使用纤维蛋白胶和氰基丙烯酸酯等组织密封剂也很有效。内窥镜设备的选择应根据个案和患者的具体情况而定,并仔细考虑缺损的性质。需要进一步开展涉及更多患者群体的广泛研究,以提供更有力的证据证明内窥镜方法在处理胃吻合口后渗漏方面的疗效。
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来源期刊
Journal of Gastric Cancer
Journal of Gastric Cancer Biochemistry, Genetics and Molecular Biology-Cancer Research
CiteScore
4.30
自引率
12.00%
发文量
36
期刊介绍: The Journal of Gastric Cancer (J Gastric Cancer) is an international peer-reviewed journal. Each issue carries high quality clinical and translational researches on gastric neoplasms. Editorial Board of J Gastric Cancer publishes original articles on pathophysiology, molecular oncology, diagnosis, treatment, and prevention of gastric cancer as well as articles on dietary control and improving the quality of life for gastric cancer patients. J Gastric Cancer includes case reports, review articles, how I do it articles, editorials, and letters to the editor.
期刊最新文献
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