Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA.
Department of Gastroenterology, Cooper University Hospital, Camden, NJ, USA.
Surg Endosc. 2024 Sep;38(9):4839-4845. doi: 10.1007/s00464-024-11133-x. Epub 2024 Aug 14.
There is a discrepancy in the surgical and endoscopic literature for managing duodenal perforations. Although often managed conservatively, surgical repair is the standard treatment for duodenal perforations. This contrasts with the gastroenterology literature, which now recommends endoscopic repair of duodenal perforations, which are more frequently iatrogenic from the growing field of advanced endoscopic procedures. This study aims to provide a scoping review to summarize the current literature content and quality on endoscopic repair of duodenal perforations.
The protocol for performing this scoping review was outlined by the Joanna Briggs Institute. All studies that reported primary outcomes of patients who had undergone endoscopic repair of duodenal perforations before February 2022, regardless of perforation etiology or repair type were reviewed, with studies after 1999 meeting inclusion criteria. The study excluded articles that did not report clinical outcomes of endoscopic repair, articles that did not describe where in the gastrointestinal tract the endoscopic repair occurred, pediatric patients, and animal studies.
7606 abstracts were screened, with 474 full articles reviewed and 152 studies met inclusion criteria. 560 patients had duodenal perforations repaired endoscopically, with a technical success rate of 90.4% and a survival rate of 86.7%. Most of these perforations (74.5%) were iatrogenic from endoscopic procedures or surgery. Only one randomized control trial (RCT) was found, and 53% of studies were case reports.
These results suggest that endoscopic repair could emerge as a viable first-line treatment for duodenal perforation and highlight the need for more high-quality research in this topic.
在处理十二指肠穿孔的外科和内镜文献中存在差异。尽管通常采用保守治疗，但手术修复是十二指肠穿孔的标准治疗方法。这与胃肠病学文献形成对比，胃肠病学文献现在推荐内镜修复十二指肠穿孔，这些穿孔更常由于先进内镜手术领域的不断发展而导致医源性穿孔。本研究旨在进行范围综述，以总结目前关于内镜修复十二指肠穿孔的文献内容和质量。
本范围综述的方案由 Joanna Briggs 研究所制定。所有报告在 2022 年 2 月之前接受过内镜修复十二指肠穿孔的患者主要结局的研究均进行了回顾，无论穿孔病因或修复类型如何，符合 1999 年后纳入标准的研究都包括在内。该研究排除了未报告内镜修复临床结局的文章、未描述内镜修复发生在胃肠道何处的文章、儿科患者和动物研究的文章。
筛选了 7606 篇摘要，共审查了 474 篇全文，有 152 项研究符合纳入标准。560 例患者接受内镜修复十二指肠穿孔，技术成功率为 90.4%，存活率为 86.7%。这些穿孔大多（74.5%）是内镜操作或手术所致医源性穿孔。仅发现一项随机对照试验（RCT），53%的研究为病例报告。
这些结果表明，内镜修复可能成为十二指肠穿孔的可行一线治疗方法，并强调了在这一主题中需要更多高质量的研究。
