Departments of Gastroenterology & Hepatology.
Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
J Clin Gastroenterol. 2021 Aug 1;55(7):551-576. doi: 10.1097/MCG.0000000000001451.
Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.
To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.
A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.
Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise.
Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
减重手术漏导致发病率和死亡率显著增加。专家报告了各种治疗方法，但没有统一的指南或共识。
回顾胃袖套漏的发病机制、危险因素、预防和治疗，重点介绍内镜方法。此外，评估了不同治疗方式的疗效和成功率。
通过对 5 个在线电子数据库（PubMed、PubMed Central、Cochrane、EMBASE 和 Web of Science）从创建到 2020 年 3 月的全面文献检索，进行了综合回顾。包括评估胃袖套漏的研究。应用与“内镜”、“漏”、“袖套”、“胃切除术”、“吻合”和“减重”相关的 MeSH 术语制定了高度敏感的检索策略。主要结局为流行病学、病理生理学、诊断、治疗和结局。
文献检索得到 2418 项研究，其中 438 项被纳入综述。对于漏，休克和腹膜炎需要早期手术干预。急性和早期漏的内镜治疗包括以下一种或多种方式：（i）缺损闭合，（ii）壁分流，或（iii）壁排除。如果内镜治疗 6 个月后仍无法控制漏，需要进行手术修正。慢性漏需要一种或多种内镜、放射或手术方法来引流积液，以促进充分愈合。成功率取决于提供者和中心的专业知识。
胃袖套切除术后漏的内镜管理是一种微创且有效的手术替代方法。它们的效果可能因临床表现、时间或漏形态而异，应根据适当的内镜治疗方式进行调整。
