Zhang Yiqun, Zhou Pinghong
Endoscopic Center, Zhongshan Hospital Fudan University Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Feb 25;20(2):160-165.
Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
内镜检查在胃癌术后并发症的诊断和治疗中发挥着重要作用。内镜干预可避免二次手术，已引起广泛关注。胃切除术后早期胃吻合口出血最为常见。随着技术的发展，急诊内镜检查和内镜止血提供了一种新的治疗方法。根据具体情况，内镜医师可选择金属夹止血、电凝止血、局部注射肾上腺素或硬化剂以及喷洒特定止血剂。吻合口瘘是一种严重的术后并发症。除了在内镜下放置小肠营养管进行早期肠内营养支持治疗外，还可选择内镜治疗，包括放置支架、金属夹、OTSC和Over-stitch缝合系统来闭合瘘口。对于吻合口梗阻或狭窄，可选择内镜下球囊或探条扩张以及放置支架。对于胃食管手术后食管吻合口难治性梗阻，用钩刀或IT刀进行梗阻部位的放射状切开（一种名为ERI的新方法）是一个不错的选择。胆管损伤引起的胆漏可通过放置支架或鼻胆管进行治疗。此外，内镜方法还广泛应用于以下方面：腹部脓肿可通过内镜下直接干预进行治疗；粘连性肠梗阻可在内镜引导下放置导管进行吸引减压治疗；碱性反流性胃炎可通过内镜迅速诊断；主要由癌症复发引起的胃出口梗阻可通过放置金属支架缓解，内镜与X线联合使用可提高成功率；近端胃切除术中迷走神经损伤引起的幽门功能障碍和痉挛可通过内镜下幽门肌切开术（一种名为G-POEM的新方法）进行治疗，短期效果显著。内镜黏膜下剥离术（ESD）可完整切除残留的胃癌前病变，然而该手术应由经验丰富的内镜医师进行。
