极端减重内镜：在 Roux-en-Y 胃旁路手术后用支架重新连接胃袋和胃肠吻合口。
Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass.
机构信息
Gastroenterology Department, University of São Paulo, Rua Ana Vieira de Carvalho 362/15, São Paulo, 05679-065, Brazil.
出版信息
Surg Endosc. 2012 May;26(5):1481-4. doi: 10.1007/s00464-011-2060-z. Epub 2011 Dec 17.
BACKGROUND
Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient.
METHODS
A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb.
RESULTS
Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total closure of the fistula was reported 30 days afterward.
CONCLUSIONS
Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.
背景
在减重手术的可能并发症中，瘘管和胃缝线部分裂开是众所周知的。经常需要再次手术，但会导致严重的发病率。一些减重并发症的内镜治疗是可行和有效的。
方法
在胃食管交界处和肠内空肠支之间放置改良的金属支架，允许鼻肠喂养管进入空肠支。
结果
内镜检查显示胃袋处几乎整个吻合钉线都断裂。放置了改良的支架，允许伤口愈合。31 天后，支架发生迁移并经内镜取出。30 天后报告瘘管完全闭合。
结论
内镜治疗某些减重手术并发症是可行的，以前已有报道。本报告介绍了一例严重漏诊患者，通过放置自膨式金属支架来桥接瘘管。
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