一项评估紧急内镜检查对胃十二指肠穿孔有效性和安全性的初步研究。

A pilot study to evaluate the effectiveness and safety of urgent endoscopy for gastroduodenal perforation.

作者信息

Asayama Naoki, Nagata Shinji, Kano Mikihiro, Shigita Kenjiro, Aoyama Taiki, Fukumoto Akira, Mukai Shinichi

机构信息

Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.

Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.

出版信息

Surg Endosc. 2022 Apr;36(4):2614-2622. doi: 10.1007/s00464-021-08555-2. Epub 2021 May 19.

DOI:10.1007/s00464-021-08555-2

PMID:34009476

Abstract

BACKGROUND

Gastroduodenal perforation is potentially life threatening and requires early diagnosis and treatment. Urgent endoscopy facilitates detecting bleeding sites and achieving hemostasis. However, there is no consensus on urgent endoscopy for gastroduodenal perforation in Japan.

METHODS

We evaluated the effectiveness and safety of urgent endoscopy for gastroduodenal perforation. We compared clinical characteristics between 140 patients who underwent urgent endoscopy (urgent endoscopy group) and 16 patients did not (no urgent endoscopy group) at Hiroshima City Asa Citizens Hospital between December 2005 and December 2018.

RESULTS

Endoscopic diagnosis was possible in all urgent endoscopy group. In contrast, correct diagnosis of the perforation site was made on CT in 99 cases (63%). Furthermore, the proportion of cases with correct diagnosis of the perforation site by CT findings differed significantly between the urgent endoscopy group and the no urgent endoscopy group (66% vs. 38%, p < 0.05). No complications of urgent endoscopy were observed. Primary perforation site was gastric in 42 cases and duodenal in 114. In the 42 gastric perforation cases, 12 gastric perforation cases (29%) were managed conservatively, successfully in 9 (75%); 2 cases (17%) required delayed emergency surgery for worsening peritonitis. In the 114 duodenal perforation cases (duodenal ulcer in all cases), 52 cases (46%) were managed conservatively, successfully in 48 (92%); 3 cases (6%) required delayed emergency surgery for worsening peritonitis. A significantly higher proportion of gastric perforation cases than duodenal perforation cases required surgical treatment (76% vs. 57%, p < 0.05). Multivariate analysis revealed localized abdominal pain (no peritonism) (OR 0.25; 95% CI 0.08-0.75; p < 0.01) and perforation diameter ≤ 5 mm (OR 0.13; 95% CI 0.04-0.36; p < 0.01) as significant independent clinical factors for successful conservative management of duodenal ulcer perforation.

CONCLUSIONS

Urgent endoscopy in gastroduodenal perforation enabled primary diagnosis and perforation site identification, and facilitated deciding the management strategy.

摘要

背景

胃十二指肠穿孔有潜在生命危险，需要早期诊断和治疗。急诊内镜有助于检测出血部位并实现止血。然而，在日本，对于胃十二指肠穿孔的急诊内镜检查尚无共识。

方法

我们评估了胃十二指肠穿孔急诊内镜检查的有效性和安全性。我们比较了2005年12月至2018年12月期间在广岛市阿佐市民医院接受急诊内镜检查的140例患者（急诊内镜组）和未接受急诊内镜检查的16例患者（非急诊内镜组）的临床特征。

结果

急诊内镜组均可行内镜诊断。相比之下，99例（63%）通过CT正确诊断了穿孔部位。此外，急诊内镜组和非急诊内镜组通过CT检查结果正确诊断穿孔部位的病例比例有显著差异（66%对38%，p<0.05）。未观察到急诊内镜检查的并发症。原发性穿孔部位胃穿孔42例，十二指肠穿孔114例。在42例胃穿孔病例中，12例（29%）采用保守治疗，9例（75%）成功；2例（17%）因腹膜炎恶化需要延迟急诊手术。在114例十二指肠穿孔病例（均为十二指肠溃疡）中，52例（46%）采用保守治疗，48例（92%）成功；3例（6%）因腹膜炎恶化需要延迟急诊手术。胃穿孔病例需要手术治疗的比例显著高于十二指肠穿孔病例（76%对57%，p<0.05）。多因素分析显示，局限性腹痛（无腹膜炎）（OR 0.25；95%CI 0.08 - 0.75；p<0.01）和穿孔直径≤5mm（OR 0.13；95%CI 0.04 - 0.36；p<0.01）是十二指肠溃疡穿孔成功保守治疗的重要独立临床因素。