食管漏的诊断和内镜治疗:系统回顾

Bram D. Vermeulen MD, Peter D. Siersema MD, PhD
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引用次数: 2

摘要

当怀疑食管渗漏时,诊断检查通常从内窥镜检查开始,然后进行胸部CT检查。临床医生应将食管漏视为临床急症,因为早期诊断和治疗可改善预后。诊断后,在具有适当多学科基础设施和专业知识的专业中心进行急性治疗管理,因为创新的内窥镜治疗选择已成为侵入性手术干预的合理选择。有希望的内镜治疗方案包括食管支架置入、内镜真空治疗和镜外夹置入。为了评估目前的文献,我们对采用这些内镜治疗方案治疗良性食管穿孔和吻合口瘘的患者的临床结果进行了系统的文献检索。系统检索得出15项研究(932例患者)讨论支架置入,14项研究(295例患者)讨论内镜真空治疗,8项研究(41例患者)讨论镜外夹置入。大多数患者取得了临床成功。然而,这些研究主要由小的单中心回顾性病例系列组成。因此,在考虑食管漏的内镜治疗时,建议慎重选择患者。此外,临床工具可能有助于预测患者的预后和选择可能受益于内镜治疗的患者。在未来的日常临床实践中,需要随机研究比较现有的内镜治疗方案,以指导食管漏患者的治疗选择。
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Diagnosis and endoscopic treatment of esophageal leakage: a systematic review

When esophageal leakage is suspected, diagnostic work-up usually starts with endoscopy followed by CT of the thorax. Clinicians should consider esophageal leakage a clinical emergency as early diagnosis and treatment are associated with improved outcome. Upon diagnosis, acute therapeutic management in a specialized center with appropriate multidisciplinary infrastructure and expertise is indicated as innovative endoscopic treatment options have become reasonable alternatives to invasive surgical interventions. Promising endoscopic treatment options include esophageal stent placement, endoscopic vacuum therapy, and over-the-scope clip placement. In effort to evaluate the current literature, a systematic literature search was performed on studies reporting clinical outcome of patients treated with these endoscopic treatment options for benign esophageal perforations and anastomotic leakage. The systematic search yielded 15 studies (932 patients) discussing stent placement, 14 studies (295 patients) discussing endoscopic vacuum therapy, and 8 studies (41 patients) discussing over-the-scope clip placement. Clinical success was achieved in the majority of all patients. However, the studies predominantly consisted of small single-center retrospective case series. Careful selection of patients is therefore recommended when considering endoscopic therapy for esophageal leakage. Furthermore, clinical tools may aid in predicting patients’ prognosis and selection of patients that could benefit from endoscopic therapy. In the future, randomized studies comparing available endoscopic treatment options are needed to guide treatment choice for patients with esophageal leakage in daily clinical practice.

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来源期刊
Techniques in Gastrointestinal Endoscopy
Techniques in Gastrointestinal Endoscopy GASTROENTEROLOGY & HEPATOLOGY-
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期刊介绍: The purpose of each issue of Techniques in Gastrointestinal Endoscopy is to provide a comprehensive, current overview of a clinical condition or surgical procedure in gastrointestinal endoscopy, combining the effectiveness of an atlas with the timeliness of a journal. Each issue places a vigorous emphasis on diagnosis, rationale for and against a procedure, actual technique, management, and prevention of complications. The journal features abundant illustrations, line drawings and color artwork to guide readers through even the most complicated procedure.
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