Shim Choong Nam, Kim Hyoung-Il, Hyung Woo Jin, Noh Sung Hoon, Song Mi Kyung, Kang Dae Ryong, Park Jun Chul, Lee Hyuk, Shin Sung Kwan, Lee Yong Chan, Lee Sang Kil
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea,
Surg Endosc. 2014 Mar;28(3):833-40. doi: 10.1007/s00464-013-3228-5. Epub 2013 Oct 10.
Anastomotic leaks are a life-threatening complication of gastrectomies with high mortality after surgical reintervention. Endoscopic therapy using fibrin glue injection, endoclip, and other devices is an alternative to surgical intervention for anastomotic leaks. Recently, self-expanding metal stents (SEMS) were introduced to treat anastomotic leaks. The purpose of this study was to assess the clinical characteristics and therapeutic outcomes of SEMS and nonstent endoscopic therapy (NSET) for treatment of anastomotic leaks after total gastrectomy with the aim of assisting endoscopists in choosing a treatment method.
Between July 2002 and March 2013, 13 patients treated with SEMS and 14 patients treated with NSET for anastomotic leaks after total gastrectomy were enrolled onto the study. Enrolled patients received 16 SEMS placement sessions and 21 NSET sessions.
No significant differences in baseline characteristics or clinical characteristics related to leakage were detected in patients with SEMS compared to NSET. The successful sealing rate at the first attempt by SEMS was significantly better than that of NSET (80.0 vs. 28.6 %, P = 0.036), whereas the successful sealing rate after multiple endoscopic treatments was not statistically different (80.0 vs. 64.3 %, P = 0.653). The main reason for reintervention with SEMS was complications and with NSET was nonseal (P = 0.004). Clinical outcomes including length of hospital stay, endoscopic treatment-related mortality, and all-cause mortality were not significantly different between the 2 groups.
In terms of efficacy by single effort, SEMS was superior to other methods for treating anastomotic leaks after total gastrectomy. However, complications with SEMS should be considered when choosing an endoscopic treatment method.
吻合口漏是胃切除术的一种危及生命的并发症，手术再次干预后的死亡率很高。使用纤维蛋白胶注射、内镜夹及其他器械的内镜治疗是吻合口漏手术干预的一种替代方法。最近，自膨式金属支架（SEMS）被用于治疗吻合口漏。本研究的目的是评估SEMS和非支架内镜治疗（NSET）在全胃切除术后吻合口漏治疗中的临床特征和治疗效果，旨在帮助内镜医师选择治疗方法。
2002年7月至2013年3月，13例全胃切除术后吻合口漏接受SEMS治疗的患者和14例接受NSET治疗的患者纳入本研究。纳入患者接受了16次SEMS置入和21次NSET治疗。
与NSET相比，接受SEMS治疗的患者在基线特征或与渗漏相关的临床特征方面未检测到显著差异。SEMS首次尝试成功封堵率显著高于NSET（80.0%对28.6%，P = 0.036），而多次内镜治疗后的成功封堵率无统计学差异（80.0%对64.3%，P = 0.653）。SEMS再次干预的主要原因是并发症，NSET是封堵失败（P = 0.004）。两组在住院时间、内镜治疗相关死亡率和全因死亡率等临床结局方面无显著差异。
就单次治疗效果而言，SEMS在治疗全胃切除术后吻合口漏方面优于其他方法。然而，选择内镜治疗方法时应考虑SEMS的并发症。
