Fujita Akashi, Tashima Tomoaki, Tanisaka Yuki, Mizuide Masafumi, Ogawa Tomoya, Saito Yoichi, Katsuda Hiromune, Miyaguchi Kazuya, Mashimo Yumi, Nakano Yuya, Terada Rie, Jinushi Ryuhei, Ryozawa Shomei
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan.
DEN Open. 2021 Aug 22;2(1):e48. doi: 10.1002/deo2.48. eCollection 2022 Apr.
Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for pancreatobiliary diseases require advanced techniques. We usually use an oblique-viewing endoscope in such procedures. Sometimes, tumor invasion causes gastrointestinal strictures. Crossing a stricture using an oblique-viewing endoscope is more difficult than using a forward-viewing scope. Therefore, the frequency of scope perforation is higher than other endoscopic procedures. Although surgical repair for gastrointestinal perforations caused by endoscopes has been performed, patients with pancreatobiliary diseases are often elderly and in poor general condition; therefore, patients are hesitant to undergo surgical treatments. Recently, the usefulness of over-the-scope clipping (OTSC) as a minimally invasive rescue method has also been reported. In this study, we report cases of successful endoscopic closure using OTSC for gastrointestinal perforations caused by endoscopes in ERCP and EUS-related procedures. After those procedures, all cases showed no abnormalities in blood tests or symptoms, and emergency surgery was successfully avoided. Thus, endoscopic closure using OTSC for pancreatobiliary endoscopy-related gastrointestinal perforations is safe and effective. However, OTSC requires some expertise. A good assessment of defect size and careful insertion of the scope using OTSC attached to the upper esophagus are needed to avoid clip migration or disinsertion and esophageal tears. Therefore, endoscopic closure using OTSC could be the first choice of treatment for pancreatobiliary endoscopy-related gastrointestinal perforations. We should be familiar with its indication and perform it carefully and rapidly.
用于胰腺和胆道疾病的内镜超声检查（EUS）及内镜逆行胰胆管造影（ERCP）需要先进的技术。在这类操作中我们通常使用斜视内镜。有时，肿瘤侵犯会导致胃肠道狭窄。使用斜视内镜穿过狭窄部位比使用前视内镜更困难。因此，内镜穿孔的发生率高于其他内镜检查操作。虽然已经开展了针对内镜所致胃肠道穿孔的手术修复，但患有胰腺和胆道疾病的患者往往年事已高且全身状况较差；所以，患者对接受手术治疗心存顾虑。最近，也有报道称使用套扎器（OTSC）作为一种微创补救方法的有效性。在本研究中，我们报告了在ERCP和EUS相关操作中使用OTSC成功内镜闭合内镜所致胃肠道穿孔的病例。在这些操作之后，所有病例的血液检查及症状均未显示异常，且成功避免了急诊手术。因此，使用OTSC对胰腺和胆道内镜相关胃肠道穿孔进行内镜闭合是安全有效的。然而，OTSC需要一定的专业技能。需要对缺损大小进行良好评估，并小心地使用附着于食管上段的OTSC插入内镜，以避免夹子移位或脱落以及食管撕裂。因此，使用OTSC进行内镜闭合可能是胰腺和胆道内镜相关胃肠道穿孔治疗的首选方法。我们应该熟悉其适应证，并谨慎且迅速地进行操作。
