Interdisciplinary Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany.
Gastrointest Endosc. 2010 Nov;72(5):1020-6. doi: 10.1016/j.gie.2010.07.029.
Esophageal full-thickness wall repair is an important but unsolved issue in endoscopy. It is unknown how well endoscopic clip closure (ECC) and endoscopic closure with suturing (ECS) perform compared with the criterion standard of thoracoscopic closure (TC).
Comparison of technical success, feasibility, long-term patency, complications, and histological quality of the different closure techniques (ECC, ECS, TC) for esophageal perforations.
Comparative animal study.
Approved animal facility.
Eighteen pigs.
Eighteen pigs were randomized, 6 each into 3 groups (ECC, ECS, TC). After endoscopic wall incision and mediastinoscopy, closure was performed by using 1 of the 3 techniques. After 8 to 12 weeks, pre-euthanasia endoscopic, necropsy, histological, and morphometric analyses were performed.
Long-term survival and histological quality of the repair.
The closure of the esophageal incisions was successful in all pigs. On days 2 and 6, 1 animal died of mediastinitis, 1 in the ECS group because of reflux of gastric contents into the mediastinum before the repair and 1 in the TC group because of leakage of the sutured closure (P = 1.0). No strictures were seen on prenecropsy endoscopy. At necropsy, 1 mediastinal abscess was found in an ECS animal (P = 1.0). Minor complications included periesophageal adhesions and reactive lymph nodes in 3 of 6 (ECC group) and 5 of 6 (TC and ECS groups). Histology showed muscle layer defects up to 12 mm in width and 21 mm in length, with a trend toward smaller defect size of width and length in the ECS group of animals.
Animal study of limited size.
Overall, ECS and ECC performed similarly to TC. ECS showed the smallest histological defects in the long-term repair.
食管全层壁修复是内镜治疗中的一个重要但尚未解决的问题。目前尚不清楚内镜夹闭（ECC）和内镜缝合闭合（ECS）与胸腔镜闭合（TC）的标准相比效果如何。
比较不同闭合技术（ECC、ECS、TC）治疗食管穿孔的技术成功率、可行性、长期通畅性、并发症和组织学质量。
对比动物研究。
经批准的动物设施。
18 头猪。
18 头猪随机分为 3 组（ECC、ECS、TC），每组 6 头。内镜切开食管壁和纵隔镜检查后，使用 3 种技术中的 1 种进行闭合。8 至 12 周后进行术前内镜、尸检、组织学和形态计量学分析。
长期生存和修复的组织学质量。
所有猪的食管切口均成功闭合。第 2 天和第 6 天，1 头猪因纵隔炎死亡，1 头 ECS 组动物因修复前胃内容物反流至纵隔而死亡，1 头 TC 组动物因缝合闭合漏出而死亡（P = 1.0）。术前内镜未见狭窄。尸检时，1 头 ECS 动物发现纵隔脓肿（P = 1.0）。轻微并发症包括食管周围粘连和反应性淋巴结，在 ECC 组的 3 头猪（ECC 组）和 TC 和 ECS 组的 5 头猪中发现。组织学显示肌肉层缺陷宽度达 12mm，长度达 21mm，ECS 组动物的缺陷宽度和长度有变小的趋势。
规模有限的动物研究。
总体而言，ECS 和 ECC 与 TC 效果相当。ECS 在长期修复中显示出最小的组织学缺陷。
