Avcioglu Ufuk, Ölmez Şehmus, Pürnak Tuğrul, Özaslan Ersan, Altıparmak Emin
Department of Gastroenterology and Hepatology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Arch Med Sci. 2015 Oct 12;11(5):970-7. doi: 10.5114/aoms.2015.52347.
Postoperative benign anastomotic strictures (POBAS) which develop after surgical resections of the gastrointestinal system (GIS) present with symptoms depending on location of the stricture. Diagnosis is confirmed by endoscopic and radiological methods. Although bougie or balloon dilatation is preferred in management, the endoscopic incision method (EIM) is also used with considerable success. In this trial, we aimed to evaluate EIM, which is one of the endoscopic dilatation techniques used in postoperative anastomotic stricture of GIS.
A total of 20 POBAS patients, 12 men and 8 women, subjected to EIM intervention for strictures, were enrolled in the trial. The number of patients with upper GIS strictures was 6 (30%), while the number of cases with lower GIS strictures was 14 (70%).
Dilatation of the stricture was achieved in 15 (75%) patients with one treatment session, while more than one session of EIM was needed in 5 (25%) cases. Mean duration of follow-up of patients was 10.65 ±5.86 (0-25) months. Procedure-related complications developed in 8 patients. Among them, 7 were minor complications and improved without any treatment. In only 1 (5%) patient, perforation was observed as a major complication. Following EIM, recurrence of POBAS was observed in 5 (25%) patients. The following parameters were found to have an impact on successful outcome in EIM: presence or absence of a tortuous lumen in POBAS (p = 0.035) and length of stricture (p = 0.02), complications during the procedure (if any), and presence of single or multiple strictures.
Endoscopic incision method may be regarded as a favorable approach among first choice treatment alternatives in uncomplicated anastomotic strictures of GIS, or it may be used as an adjunctive dilatation method.
胃肠道系统（GIS）手术切除后出现的术后良性吻合口狭窄（POBAS），其症状取决于狭窄的位置。通过内镜和放射学方法确诊。虽然在治疗中首选探条或球囊扩张术，但内镜切开术（EIM）也取得了相当大的成功。在本试验中，我们旨在评估EIM，这是一种用于GIS术后吻合口狭窄的内镜扩张技术。
共有20例接受EIM干预治疗狭窄的POBAS患者纳入试验，其中男性12例，女性8例。GIS上消化道狭窄患者6例（30%），下消化道狭窄患者14例（70%）。
15例（75%）患者经一次治疗使狭窄扩张，5例（25%）患者需要进行不止一次的EIM治疗。患者平均随访时间为10.65±5.86（0 - 25）个月。8例患者出现与手术相关的并发症。其中，7例为轻微并发症，未经任何治疗即好转。仅1例（5%）患者出现穿孔这一严重并发症。EIM治疗后，5例（25%）患者出现POBAS复发。发现以下参数对EIM的成功结果有影响：POBAS中是否存在迂曲管腔（p = 0.035）、狭窄长度（p = 0.02）、手术过程中的并发症（如有）以及单处或多处狭窄的存在。
内镜切开术可被视为GIS单纯性吻合口狭窄首选治疗方案中的一种有利方法，或者可作为辅助扩张方法使用。
