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减重手术主要并发症的内镜治疗方法

Endoscopic Approach for Major Complications of Bariatric Surgery.

作者信息

Joo Moon Kyung

机构信息

Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea.

出版信息

Clin Endosc. 2017 Jan;50(1):31-41. doi: 10.5946/ce.2016.140. Epub 2016 Dec 23.

Abstract

As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

摘要

随着东亚地区的生活方式和饮食模式逐渐西化,肥胖症的患病率迅速上升。减重手术,如Roux-en-Y胃旁路术(RYGB)、袖状胃切除术(SG)和腹腔镜可调节胃束带术(LAGB),被认为是重度肥胖患者的一线治疗选择。然而,术后并发症有所增加,对这些并发症的妥善管理,包括内镜手术的应用,变得至关重要。最严重的并发症,如渗漏和瘘管,可通过内镜下放置支架和注射纤维蛋白胶进行治疗,一种新型的全层闭合内镜夹(OTSC)已用于治疗术后渗漏。RYGB术后胃空肠(GJ)吻合口处或SG中角切迹处的狭窄可使用支架或内镜球囊扩张进行处理。GJ吻合口或胃囊的扩张可能导致体重减轻失败,人们已尝试使用内镜硬化疗法、新型内镜缝合装置和OTSC。胃束带的胃内移位可使用各种内镜工具成功治疗。内镜检查在减重术后并发症的管理中起着关键作用,内镜医师和减重外科医生之间的密切合作可能会进一步提高内镜手术的成功率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/de3a/5299989/263845463ad9/ce-2016-140f1.jpg

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