Gastroenterología, Hospital Nacional Edgardo Rebagliati Martins, Perú.
Gastroenterología, Hospital Nacional Edgardo Rebagliati Martins.
Rev Esp Enferm Dig. 2020 Oct;112(10):772-777. doi: 10.17235/reed.2020.6880/2020.
colorectal perforations are one of the most feared complications after performing an endoscopic resection. The use of endoclips is considered for the management of these complications.
to evaluate the efficacy and safety of the use of endoclips in the management of perforations and deep mural injuries that occur after an endoscopic colorectal resection.
a prospective cohort of consecutively included patients was used with a diagnosis of perforation or deep mural injury after an endoscopic colorectal resection treated with endoclips in our institution. The rates of perforation and deep mural injury were obtained. The factors associated with an unfavorable evolution after the placement of the endoclips were analyzed.
after 342 endoscopic mucosal resections (EMR) and 42 endoscopic submucosal dissections (ESD), there were 25 cases with perforation or deep mural injury. The deep mural injury rate was 3.22 % and 7.14 % in the case of EMR and ESD, respectively. The perforation rate was 1.46 % and 14.29 % in the case of EMR and ESD, respectively. Successful closure with endoclips was achieved in 24 cases (96 %). Only one patient presented an unfavorable evolution (10 %) after successful closure. The factors associated with an unfavorable evolution were the presence of diffuse peritoneal symptoms and a perforation size greater than or equal to 10 mm.
endoscopic closure with endoclips is effective to avoid surgery in cases of deep mural injury or perforation after an endoscopic resection.
结直肠穿孔是内镜切除术后最可怕的并发症之一。使用内镜夹被认为是这些并发症的一种处理方法。
评估内镜夹在结直肠内镜切除术后发生穿孔和深层壁损伤的管理中的疗效和安全性。
采用前瞻性队列研究，连续纳入在我院接受内镜夹治疗的内镜结直肠切除术后穿孔或深层壁损伤患者。获得穿孔和深层壁损伤的发生率。分析与内镜夹放置后不良转归相关的因素。
在 342 例内镜黏膜切除术（EMR）和 42 例内镜黏膜下剥离术（ESD）后，有 25 例发生穿孔或深层壁损伤。EMR 和 ESD 中深层壁损伤发生率分别为 3.22%和 7.14%。穿孔发生率分别为 1.46%和 14.29%。24 例（96%）患者成功用内镜夹闭合。只有 1 例患者（10%）在成功闭合后出现不良转归。与不良转归相关的因素是弥漫性腹膜症状和穿孔大小≥10mm。
对于内镜切除术后发生的深层壁损伤或穿孔，内镜夹闭合可有效避免手术。
