Lee Sung Ryol, Kim Hyung Ook, Park Jung Ho, Yoo Chang Hak
Departments of Surgery.
Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Surg Laparosc Endosc Percutan Tech. 2018 Apr;28(2):113-117. doi: 10.1097/SLE.0000000000000513.
Management of esophagojejunostomy leakage (EJL) has a high mortality rate and increases length of hospital stay. The aim of this study was to evaluate the feasibility of early postoperative gastroduodenoscopy and stent insertion to control EJL after total gastrectomy for gastric adenocarcinoma.
Among 421 patients, 13 exhibited EJL. Of the 13 patients, 8 were treated with a covered self-expandable metal stent (SEMS) inserted by endoscopy and 5 patients were treated with surgery or conservative treatment.
The mortality rate was 0% in the SEMS-treated group. The median duration from primary surgery to discovery of leakage was 3.00 days overall [interquartile range (IQR), 2.00 to 5.50 d]. The time to enteral feeding after operation was 24.00 days (IQR, 18.00 to 31.00 d). Median postoperative hospital days was 35.0 days (IQR, 21.00 to 65.00 d). Median duration from leakage to gastroduodenoscopy was 7.00 days (IQR, 1.25 to 14.50 d). On endoscopic findings, most sizes of leakage site were 25% or smaller (8/9, 88.9%) within whole anastomosis size. Eight patients were treated by SEMS. No endoscopic procedure-related or leakage-related deaths occurred.
The promising results for endoscopic treatment in this study showed that early endoscopic treatment using a covered SEMS for EJL might be a feasible, safe, and effective method in selected patients.
食管空肠吻合口漏（EJL）的管理死亡率高且会延长住院时间。本研究的目的是评估术后早期胃十二指肠镜检查及支架置入术在胃腺癌全胃切除术后控制EJL的可行性。
在421例患者中，13例出现EJL。这13例患者中，8例接受了内镜下置入覆膜自膨式金属支架（SEMS）治疗，5例接受了手术或保守治疗。
SEMS治疗组的死亡率为0%。从初次手术到发现吻合口漏的中位时间总体为3.00天[四分位间距（IQR），2.00至5.50天]。术后开始肠内喂养的时间为24.00天（IQR，18.00至31.00天）。术后中位住院天数为35.0天（IQR，21.00至65.00天）。从吻合口漏到进行胃十二指肠镜检查的中位时间为7.00天（IQR，1.25至14.50天）。在内镜检查结果中，在整个吻合口大小范围内，大多数漏口大小为25%或更小（8/9，88.9%）。8例患者接受了SEMS治疗。未发生与内镜操作相关或与吻合口漏相关的死亡。
本研究中内镜治疗的良好结果表明，对于选定患者，使用覆膜SEMS对EJL进行早期内镜治疗可能是一种可行、安全且有效的方法。
