Raithel M, Albrecht H, Scheppach W, Farnbacher M, Haupt W, Hagel A F, Schellerer V, Vitali F, Neurath M F, Schneider H T
Department of Medicine II, Gastroenterology and Interventional Endoscopy, Waldkrankenhaus St. Marien, Erlangen, Germany.
Department of Medicine 1, Gastroenterology, University Erlangen, Erlangen, Germany.
Surg Endosc. 2017 Jun;31(6):2411-2425. doi: 10.1007/s00464-016-5242-x. Epub 2016 Sep 15.
Acute gastrointestinal (GI) wall defects contain a high risk of morbidity and mortality and may be closed endoscopically by a full-thickness over-the-scope clip (OTSC).
Unselected consecutive patients presenting with acute non-surgical perforations or postoperative anastomotic leaks or perforations underwent attempted OTSC placement as primary closure method after interdisciplinary consensus in three tertiary referral centres. Their clinical data and intervention characteristics were evaluated in an intention to treat analysis during a 24-month period to assess closure rates, 30-day mortality, hospitalization and comorbidity.
In total, 34 patients (16 females, 18 males, 69.5 years) were included with 22 non-surgical perforations and 12 postoperative anastomotic leaks or perforations. Definitive closure of the perforations and leaks was achieved in 26/34 patients (76.5 %). Successful closure of the GI wall defect resulted in a significantly shorter hospital stay (8 days, p = 0.03) and was significantly correlated with comorbidity (r = 0.56, p = 0.005). In the group with OTSC failure, hospitalization was 18 days and 6 of 8 patients (75 %) required immediate surgery. Three deaths occurred in the group with successful OTSC closure due to comorbidity, while one death in the OTSC failure group was related to a refractory perforation. Favourable indications and locations for a successful OTSC procedure were identified as PEG complications, endoscopic or postoperative leaks of stomach, colon or rectum, respectively.
In unselected patients, OTSC was effective for closure of acute GI wall defects in more than 75 % of all patients. Clinical success and short hospitalization were best achieved in patients without comorbidity, but closure of the perforation or the anastomotic leak was found to be not the only parameter relevant for patient outcome and mortality.
急性胃肠道（GI）壁缺损具有较高的发病和死亡风险，可通过全层套扎式内镜夹（OTSC）进行内镜下闭合。
在三个三级转诊中心，经多学科共识后，对未经选择的连续出现急性非手术性穿孔、术后吻合口漏或穿孔的患者，尝试将OTSC放置作为主要闭合方法。在24个月的治疗意向性分析中评估他们的临床数据和干预特征，以评估闭合率、30天死亡率、住院情况和合并症。
总共纳入34例患者（16例女性，18例男性，平均年龄69.5岁），其中22例为非手术性穿孔，12例为术后吻合口漏或穿孔。26/34例患者（76.5%）实现了穿孔和漏口的确定性闭合。胃肠道壁缺损的成功闭合导致住院时间显著缩短（8天，p = 0.03），并且与合并症显著相关（r = 0.56，p = 0.005）。在OTSC失败组中，住院时间为18天，8例患者中有6例（75%）需要立即手术。OTSC成功闭合组中有3例因合并症死亡，而OTSC失败组中有1例死亡与难治性穿孔有关。成功的OTSC手术的有利指征和部位分别确定为经皮内镜下胃造口术（PEG）并发症、胃、结肠或直肠的内镜或术后漏口。
在未经选择的患者中，OTSC对超过75%的急性胃肠道壁缺损患者有效。无合并症的患者临床成功率最高且住院时间短，但发现穿孔或吻合口漏的闭合并非影响患者预后和死亡率的唯一参数。
