Al-Asiry Jamal, Lord Richard, Mohammed Noor
Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Ther Adv Gastrointest Endosc. 2019 Dec 26;12:2631774519895845. doi: 10.1177/2631774519895845. eCollection 2019 Jan-Dec.
Upper gastrointestinal perforations, leaks and fistulae are relatively common occurrences with a growing number of these complications occuring as a result of therapeutic advancement and adoption of newer and bolder endoscopic therapies. Historically, these were predominantly managed surgically; however, owing to high morbidity and mortality associated with surgical repair, endoscopic options are preferable. Over the past decade, vast expansion in the endoscopic armamentarium for the management of perforations, leaks and fistulae has led to endoscopic management now being the first-line treatment. Here, we will review the endoscopic modalities including through-the-scope clips, over-the-scope clips, stents, vacuum therapy, endoscopic sutures and sealants. In addition, we will discuss nonendoscopic approach to management including early recognition of perforations, ways to reduce septic complications and format algorithms to guide therapy for different scenarios. However, it is important to stress that there is a lack of high-quality randomised studies to clearly guide management of such complications, resulting in a wide variation of approaches in management by specialists. Each case requires some degree of individualisation due to the potential array of problems encountered and patient-specific co-morbidities. In the future, more robust studies are clearly required to better guide specialist management.
上消化道穿孔、渗漏和瘘管是相对常见的情况，随着治疗技术的进步以及更新、更激进的内镜治疗方法的采用，这类并发症的数量不断增加。从历史上看，这些情况主要通过手术治疗；然而，由于手术修复相关的高发病率和死亡率，内镜治疗方案更可取。在过去十年中，用于处理穿孔、渗漏和瘘管的内镜设备大幅扩展，使得内镜治疗如今成为一线治疗方法。在此，我们将回顾内镜治疗方式，包括经内镜夹、全覆膜内镜夹、支架、负压治疗、内镜缝合和密封剂。此外，我们还将讨论非内镜治疗方法，包括穿孔的早期识别、减少感染并发症的方法以及针对不同情况指导治疗的流程算法。然而，必须强调的是，缺乏高质量的随机研究来明确指导此类并发症的管理，导致专家们的管理方法差异很大。由于可能遇到的一系列问题以及患者特定的合并症，每个病例都需要一定程度的个体化处理。未来，显然需要更有力的研究来更好地指导专家管理。
