Han Sojung, Chung Hyunsoo, Park Jun Chul, Shin Sung Kwan, Lee Sang Kil, Lee Yong Chan
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Clin Endosc. 2017 May;50(3):293-296. doi: 10.5946/ce.2016.121. Epub 2017 Mar 8.
Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed. The second case was of a 15-mm large perforated gastric ulcer, which was also successfully closed with a PGA sheet. This is the first case report that PGA sheet was used for the treatment of overt perforation. The outcome of these cases suggest that endoscopic closure using PGA sheets can be considered as a useful alternative for the management of GI leakage, fistulae, and perforations.
胃肠道（GI）渗漏、瘘管和穿孔可能很严重，甚至危及生命。这些病症的管理方法已经发生了范式转变，从手术治疗转向保守治疗，包括内镜管理。在此，我们报告两例使用聚乙醇酸（PGA）片材联合纤维蛋白胶进行内镜下闭合胃肠道瘘管和穿孔的病例。第一例是胃大部切除术后胃十二指肠吻合口漏。在内镜夹应用失败后，应用了PGA片材，瘘管成功闭合。第二例是一个15毫米大的穿孔性胃溃疡，也用PGA片材成功闭合。这是首例使用PGA片材治疗明显穿孔的病例报告。这些病例的结果表明，使用PGA片材进行内镜闭合可被视为管理胃肠道渗漏、瘘管和穿孔的一种有用替代方法。
