Dennert B, Ramirez F C, Sanowski R A
Department of Medicine, Carl T. Hayden VA Medical Center, Phoenix, AZ 85012, USA.
Gastrointest Endosc. 1997 Feb;45(2):134-7. doi: 10.1016/s0016-5107(97)70235-9.
Placement of an overtube is required for endoscopic variceal ligation. The spectrum of overtube-related esophageal mucosal injury is unknown. We made a prospective comparison of two types of overtubes and a determination of the frequency, severity, and risk factors for overtube-related injury.
Two overtubes (60F, 20 cm, "new" overtube; and 60F, 25 cm, "old" overtube) were used and placed using the bougie-assisted technique. Mucosal integrity was documented before and after variceal ligation. Overtube contact time, bands number, setting (emergent versus elective), type of overtube, degree of coagulopathy, and development of symptoms after variceal ligation were recorded.
Fifty sessions in 29 patients were analyzed; 24% of sessions were emergent. The old overtube was used in 24 sessions and the new in 26. Mucosal injury occurred in 72% of sessions. Mean overtube contact time was 11.58 +/- 0.97 minutes, the mean number of bands placed per session was 6.4 +/- 0.4, and the mean international normalized ratio was 1.47 +/- 0.06. No risk factors correlated with mucosal injury except for the old overtube, which was associated with tears (p = 0.02).
Mucosal injury related to the overtube is frequent but clinically unimportant. Because mucosal tears occurred significantly more often with the old overtube, we suggest that its use should be avoided.
内镜下静脉曲张结扎术需要放置外套管。外套管相关的食管黏膜损伤范围尚不清楚。我们对两种类型的外套管进行了前瞻性比较，并确定了外套管相关损伤的频率、严重程度及危险因素。
使用两种外套管（60F，20 cm，“新型”外套管；以及60F，25 cm，“旧型”外套管），采用探条辅助技术放置。在静脉曲张结扎术前和术后记录黏膜完整性。记录外套管接触时间、套扎圈数、手术时机（急诊与择期）、外套管类型、凝血障碍程度以及静脉曲张结扎术后症状的发生情况。
对29例患者的50次手术进行了分析；24%的手术为急诊手术。24次手术使用旧型外套管，26次使用新型外套管。72%的手术出现黏膜损伤。外套管平均接触时间为11.58±0.97分钟，每次手术平均放置套扎圈数为6.4±0.4个，平均国际标准化比值为1.47±0.06。除旧型外套管与黏膜撕裂相关（p = 0.02）外，未发现与黏膜损伤相关的危险因素。
与外套管相关的黏膜损伤很常见，但临床上并不重要。由于旧型外套管导致黏膜撕裂的发生率明显更高，我们建议应避免使用。
