Gonzalez J M, Lorenzo D, Guilbaud T, Bège T, Barthet M
Aix-Marseille Univ, APHM, Service de gastroentérologie, Hôpital Nord, Marseille, France.
Aix-Marseille Univ, APHM, Service de chirurgie digestive, Hôpital Nord, Marseille, France.
Endosc Int Open. 2018 Jun;6(6):E745-E750. doi: 10.1055/s-0044-101450. Epub 2018 Jun 5.
Management of post-sleeve gastrectomy fistulas (PSGF) recently has evolved, resulting in prioritization of internal endoscopic drainage (IED). We report our experience with the technique in a tertiary center.
This was a single-center, retrospective study of 44 patients whose PSGF was managed with IED, comparing two periods: after 2013 (Group 1; n = 22) when IED was used in first line and before 2013 (Group 2; n = 22) when IED was applied in second line. Demographic data, pre-endoscopic management, characteristics of fistulas, therapeutic modalities and outcomes were recorded and compared between the two groups. The primary endpoint was IED efficacy; the secondary endpoint was a comparison of outcomes depending on the timing of IED in the management strategy.
The groups were matched in gender (16 female, 16 male), mean age (43 years old), severity of fistula, delay before treatment, and exposure to previous endoscopic or surgical treatments. The overall efficacy rate was 84 % (37/44): 86 % in Group 1 and 82 % in Group 2 (NS). There was one death and one patient who underwent surgery. The median time to healing was 226 ± 750 days (Group 1) vs. 305 ± 300 days (Group 2) (NS), with a median number of endoscopies of 3 ± 6 vs 4.5 ± 2.4 (NS). There were no differences in number of nasocavity drains and double pigtail stents (DPS), but significantly more metallic stents, complications, and secondary strictures were seen in Group 2.
IED for management of PSGF is effective in more than 80 % of cases whenever it is used during the therapeutic strategy. This approach should be favored when possible.
袖状胃切除术后瘘（PSGF）的管理近来有所发展，使得内镜下内引流（IED）成为优先选择的方法。我们报告在一家三级中心应用该技术的经验。
这是一项单中心回顾性研究，纳入44例采用IED治疗PSGF的患者，比较两个时期：2013年之后（第1组；n = 22），此时IED作为一线治疗方法；2013年之前（第2组；n = 22），此时IED作为二线治疗方法。记录并比较两组的人口统计学数据、内镜治疗前的处理、瘘的特征、治疗方式及结局。主要终点是IED的疗效；次要终点是根据管理策略中IED的时机比较结局。
两组在性别（女性16例，男性16例）、平均年龄（43岁）、瘘的严重程度、治疗前延迟时间以及既往接受内镜或手术治疗情况方面相匹配。总体有效率为84%（37/44）：第1组为86%，第2组为82%（无显著性差异）。有1例死亡，1例患者接受了手术。愈合的中位时间为226±750天（第1组）对比305±300天（第2组）（无显著性差异），内镜检查的中位次数为3±6次对比4.5±2.4次（无显著性差异）。鼻胃管引流和双猪尾支架（DPS）的数量没有差异，但第2组使用的金属支架、并发症和继发性狭窄明显更多。
无论在治疗策略中何时使用，IED治疗PSGF的有效率超过80%。只要有可能，应优先采用这种方法。
