Richter Florian, Ellrichmann Mark
Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
Interdisciplinary Endoscopy, Medical Department I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
Visc Med. 2025 Apr 1:1-9. doi: 10.1159/000545485.
Anastomotic leakage (AL) in the upper gastrointestinal tract (uGIT) is a critical condition associated with high mortality and significant morbidity. Effective management requires prompt and specialized diagnostic and therapeutic interventions through an interdisciplinary approach. In current practice, surgical intervention is infrequent and typically reserved for cases of extensive damage. Close collaboration between radiology, endoscopy, and surgery is essential for optimal care. Endoscopic therapy is the primary modality for managing AI in the upper GIT. This review offers an overview of the most common endoscopic treatment strategies for AL in this region.
Significant advancements have been made in the endoscopic management of AL in the uGIT in recent years. Endoscopic sutures and clips remain appropriate for smaller defects, but for larger leakages, endoscopic vacuum therapy (EVT) is gaining prominence over stent placement. Innovative approaches, such as vacuum stents and small diameter filmed drainage (FD), offer promising new therapeutic options for treating AL in the uGIT.
(1) Endoscopy plays a pivotal role in the management of AL in the upper GIT. (2) A growing body of evidence supports EVT as superior to other modalities such as sutures, tissue sealants, or clips. Notably, EVT has a lower complication rate and higher healing success compared to stent therapy in AL treatment. (3) New endoscopic techniques, including the vacuum stent and FD, represent promising advancements in the treatment of AL.
上消化道（uGIT）吻合口漏（AL）是一种严重情况，与高死亡率和显著的发病率相关。有效的管理需要通过多学科方法进行及时和专门的诊断及治疗干预。在当前实践中，手术干预并不常见，通常仅用于广泛损伤的病例。放射科、内镜科和外科之间的密切合作对于最佳治疗至关重要。内镜治疗是上消化道AL管理的主要方式。本综述概述了该区域AL最常见的内镜治疗策略。
近年来，上消化道AL的内镜管理取得了重大进展。内镜缝合和夹子对于较小的缺损仍然适用，但对于较大的渗漏，内镜真空治疗（EVT）比支架置入更受关注。创新方法，如真空支架和小直径覆膜引流（FD），为治疗上消化道AL提供了有前景的新治疗选择。
（1）内镜在上消化道AL的管理中起关键作用。（2）越来越多的证据支持EVT优于其他方式，如缝合、组织密封剂或夹子。值得注意的是，在AL治疗中，与支架治疗相比，EVT并发症发生率更低，愈合成功率更高。（3）新的内镜技术，包括真空支架和FD，代表了AL治疗中有前景的进展。
