Filgate Rhys, Thomas Alan, Ballal Mohammad
Fremantle Hospital, Fremantle, WA, Australia.
Surg Endosc. 2015 Jul;29(7):2006-12. doi: 10.1007/s00464-014-3903-1. Epub 2014 Nov 27.
Enteric fistulas are a recognised complication of various diseases and surgical interventions. Non-operative medical management will result in closure of 60-70% of all fistulas over a six- to eight-week period, those that fail non-operative management will require operative intervention if they are to close. We present a series of upper gastrointestinal fistula managed with endoscopic intervention and insertion of biological fistula plug over a 3-year period across three Hospitals, both public and private, in Western Australia.
Over a three-year period, 14 patients were referred for treatment of acute or persistent foregut fistulas. All fistulas were managed with endoscopic intervention and insertion of a porcine small intestine sub-mucosa plug (Biodesign (®) Cook medical Inc., Bloomington, IN, USA). No patients with fistula were excluded. Data were collected on patient demographics and underlying diagnosis. The biological plugs were deployed using three different endoscopic techniques (direct deployment via the endoscope, catheter-assisted endoscopic deployment, or a pull through via a guide wire using a rendezvous technique).
Fourteen patients with foregut fistula were treated using biological plugs. The age of the fistulas treated ranged from 14 days to 3 years. The fistulas were predominantly gastric in origin (eight cases). Three oesophageal, one gastro-pleural-bronchial, and two jejunal fistulas were also managed using this technique. Of the 14 fistulas treated using this method, 13 resolved following the treatment. Median time to closure of the fistula was 2 days (range 1-120 days). Three patients required more than one intervention to complete closure.
Biological plugs offer a further option for management of the traditionally difficult foregut fistula, without major morbidity associated with other treatment modalities. It is limited to the ability to deploy the plug endoscopically.
肠瘘是多种疾病和外科手术干预公认的并发症。非手术药物治疗可使60% - 70%的瘘管在6至8周内闭合，若非手术治疗失败，瘘管若要闭合则需手术干预。我们展示了西澳大利亚州三家公立和私立医院在三年期间通过内镜干预和插入生物瘘管封堵器治疗一系列上消化道瘘的情况。
在三年期间，14例患者因急性或持续性前肠瘘前来就诊。所有瘘管均通过内镜干预和插入猪小肠粘膜下层封堵器（美国印第安纳州布鲁明顿市库克医疗公司的Biodesign (®)）进行治疗。没有瘘管患者被排除在外。收集了患者的人口统计学数据和潜在诊断信息。生物封堵器采用三种不同的内镜技术进行放置（通过内镜直接放置、导管辅助内镜放置或使用会师技术通过导丝牵拉放置）。
14例前肠瘘患者接受了生物封堵器治疗。所治疗的瘘管病程从14天到3年不等。瘘管主要起源于胃（8例）。还使用该技术治疗了3例食管瘘、1例胃 - 胸膜 - 支气管瘘和2例空肠瘘。采用该方法治疗的14例瘘管中，13例在治疗后愈合。瘘管闭合的中位时间为2天（范围1 - 120天）。3例患者需要不止一次干预才能完成闭合。
生物封堵器为传统上难以治疗的前肠瘘提供了另一种治疗选择，且没有与其他治疗方式相关的重大发病率。其局限性在于内镜下放置封堵器的能力。
