Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Esophagus. 2021 Jul;18(3):529-536. doi: 10.1007/s10388-020-00808-8. Epub 2021 Jan 8.
Anastomotic leak is a potentially life-threatening complication following esophageal cancer surgery. In this study, we aimed to clarify the efficacy of endoscopic filling with polyglycolic acid (PGA) sheets and fibrin glue for anastomotic leak after esophageal cancer surgery.
Consecutive patients who underwent endoscopic filling with PGA sheets and fibrin glue for anastomotic leak after esophageal cancer surgery between August 2014 and January 2020 were included in the study, with its efficacy retrospectively reviewed. We performed endoscopic filling using two methods: (1) filling the fistula with PGA sheets, followed by the application of a fibrinogen and thrombin solution (conventional method) and (2) filling the fistula with PGA sheets pre-soaked in a fibrinogen solution, followed by the application of a thrombin solution (pre-soak method).
A total of 14 patients underwent endoscopic filling procedures within the study period. The endoscopic filling procedures were successfully performed in all cases and no adverse events associated with the procedures were observed. Fistula closure was obtained in 10 (71%) cases. In the 10 successful cases, the median number of procedures was 1 (range 1-3) and the median time from the first procedure to oral intake was 7.5 days (range 4-36 days). The success rate of the pre-soak method was significantly higher than that of the conventional method (90% vs. 25%, P = 0.041).
Endoscopic filling with PGA sheets and fibrin glue is a safe and effective treatment for the closure of an anastomotic leak. The pre-soak method can achieve successful endoscopic filling.
吻合口漏是食管癌手术后一种潜在危及生命的并发症。在本研究中，我们旨在阐明在食管癌手术后吻合口漏时使用聚乙二醇酸（PGA）片和纤维蛋白胶进行内镜填充的疗效。
回顾性分析 2014 年 8 月至 2020 年 1 月期间连续因食管癌手术后吻合口漏而行内镜下 PGA 片和纤维蛋白胶填充的患者，评估其疗效。我们采用两种方法进行内镜下填充：（1）用 PGA 片填充瘘管，然后应用纤维蛋白原和凝血酶溶液（常规方法）；（2）用纤维蛋白原溶液浸泡 PGA 片后填充瘘管，然后应用凝血酶溶液（预浸泡方法）。
研究期间共有 14 例患者行内镜下填充术。所有病例均成功完成内镜下填充术，未观察到与该操作相关的不良事件。10 例（71%）获得瘘管闭合。在 10 例成功病例中，内镜下填充术的中位数为 1 次（范围 1-3 次），从第一次操作到开始口服的中位数时间为 7.5 天（范围 4-36 天）。预浸泡法的成功率明显高于常规法（90%比 25%，P=0.041）。
PGA 片和纤维蛋白胶内镜下填充术是闭合吻合口漏的一种安全有效的治疗方法。预浸泡法可成功进行内镜下填充。
