Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Penn State College of Medicine, Hershey, PA, USA.
Surg Endosc. 2020 Jun;34(6):2690-2702. doi: 10.1007/s00464-019-07030-3. Epub 2019 Jul 26.
Endoscopic management of full-thickness gastrointestinal tract defects (FTGID) has become an attractive management strategy, as it avoids the morbidity of surgery. We have previously described the short-term outcomes of over-the-scope clip management of 22 patients with non-acute FTGID. This study updates our prior findings with a larger sample size and longer follow-up period.
A retrospective analysis of prospectively collected data was conducted. All patients undergoing over-the-scope clip management of FTGID between 2013 and 2019 were identified. Acute perforations immediately managed and FTGID requiring endoscopic suturing were excluded. Patient demographics, endoscopic adjunct therapies, number of endoscopic interventions, and need for operative management were evaluated. Success was strictly defined as complete FTGID closure.
We identified 92 patients with 117 FTGID (65 fistulae and 52 leaks); 27.2% had more than one FTGID managed simultaneously. The OTSC device (Ovesco Endoscopy, Tubingen, Germany) was utilized in all cases. Additional closure attempts were required in 22.2% of defects. With a median follow-up period of 5.5 months, overall defect closure success rate was 66.1% (55.0% fistulae vs. 79.6% leaks, p = 0.007). There were four mortalities from causes unrelated to the FTGID. Only 14.9% of patients with FTGID underwent operative management. There were no complications related to endoscopic intervention and no patients required urgent surgical intervention.
Over-the-scope clip management of FTGID represents a safe alternative to potentially morbid operative intervention. When strictly defining success as complete closure of all FTGID, endoscopy was successful in 64.4% of patients with only a small minority of patients ultimately requiring surgery.
内镜全层消化道缺损（FTGID）的管理已成为一种有吸引力的管理策略，因为它避免了手术的发病率。我们之前描述了 22 例非急性 FTGID 患者经内镜套扎夹管理的短期结果。本研究通过更大的样本量和更长的随访期更新了我们之前的发现。
对前瞻性收集的数据进行回顾性分析。确定了 2013 年至 2019 年间接受内镜套扎夹治疗 FTGID 的所有患者。立即处理急性穿孔和需要内镜缝合的 FTGID 除外。评估患者人口统计学、内镜辅助治疗、内镜干预次数和手术管理需求。成功严格定义为完全 FTGID 闭合。
我们共发现 92 例 117 例 FTGID（65 例瘘管和 52 例漏口）；27.2%的患者同时处理不止一个 FTGID。所有病例均使用 OTSC 装置（德国图宾根 Ovesco 内镜公司）。22.2%的缺损需要进一步闭合尝试。中位随访时间为 5.5 个月，总体缺损闭合成功率为 66.1%（瘘管 55.0%，漏口 79.6%，p=0.007）。有 4 例死亡与 FTGID 无关。仅有 14.9%的 FTGID 患者接受了手术治疗。内镜干预无相关并发症，无患者需要紧急手术干预。
内镜套扎夹治疗 FTGID 是一种替代潜在有创手术干预的安全方法。当严格定义所有 FTGID 完全闭合为成功时，内镜治疗在 64.4%的患者中取得成功，只有少数患者最终需要手术。
