Stašek Martin, Aujeský René, Vrba Radek, Loveček Martin, Chudáček Josef, Janda Petr, Gregořík Michal, Vomáčková Katherine, Neoral Čestmír, Klos Dušan
Department of Surgery I, University Hospital, Olomouc, Czech Republic.
Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2018 Jun;13(2):164-175. doi: 10.5114/wiitm.2018.72740. Epub 2018 Jan 22.
Intraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy.
To evaluate the indications, benefits and risks of IOG.
A single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed.
The cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG.
The IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.
术中食管胃十二指肠镜检查（IOG）是上消化道（UGI）病理学中针对各种特殊情况的一种诊断和治疗方法。由于证据不足且外科医生在消化内镜方面的培训有限，其适应证仍因人而异。
评估IOG的适应证、益处和风险。
对104例患者连续进行的110次IOG进行单中心回顾性研究。评估术前计划、IOG时机、术前评估、术中发现、病变定位、手术类型、预期治疗的改变及并发症。
该队列包括29例食管肿瘤、5例贲门肿瘤、36例胃肿瘤、胃肠道出血（8例）、食管憩室（3例）、穿孔（3例）、胃食管反流病（GERD，5例）、纵隔病变（3例）、瘘（4例）、营养评估（10例）、十二指肠腺瘤（2例）、溃疡病、食管狭窄和胃扭转。79%的IOG适应证在术前确定，21%在术中确定。96.4%的病变得以定位。治疗方案改为更广泛的切除术（11例）、较小的切除术（5例）、出血的定位及手术治疗（8例）或允许进行微创手术（25例）。术后共出现3例并发症，包括胃穿孔、切除线阳性（内镜下黏膜切除术/内镜黏膜下剥离术后）及再次出血。IOG患者30天死亡率达3.6%，无明确原因。
IOG是UGI病理学诊断和治疗中的一种辅助方法。它能实现手术的微创完成及治疗的个体化。
