Endotherapy of leaks and fistula  

作　　者：Mahesh Kumar Goenka Usha Goenka 

机构地区：[1]Institute of Gastro Sciences, Apollo Gleneagles Hospitals [2]Department of Imaging and Interventional Radiology, Apollo Gleneagles Hospitals

出　　处：《World Journal of Gastrointestinal Endoscopy》2015年第7期702-713,共12页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：Perforations, leaks and fistula involving gastrointestinal(GI) tract are increasing encountered in clinical practice. There is a changing paradigm for their management with surgical approach being replaced by conservative approach including endoscopic therapy. Clips(through the scope and over the scope) and covered stent are front runners for endotherapy for GI leaks and fistula.Over the scope clips introduced recently, can treat larger defects compared to through the scope clips. Covered stents are suited for larger defects and those associated with luminal narrowing. However cervical esophagus, gastro-esophageal junction, stomach and right colonic lesions may be better for clip therapy rather than stenting. Recent developments in this field include use of endovac therapy which consists of a sponge with suction device, biodegradable stent, use of fibrin glue and some endo-suturing device. Conservative therapy with no surgical or endoscopic intervention, may be suitable for a small subset of patients. An algorithm based on location, size of defect, associated stricture, infection and available expertise needs to be developed to reduce the mortality and morbidity of this difficult clinical problem.Perforations, leaks and fistula involving gastrointestinal（GI） tract are increasing encountered in clinical practice.There is a changing paradigm for their managementwith surgical approach being replaced by conservativeapproach including endoscopic therapy. Clips （throughthe scope and over the scope） and covered stent arefront runners for endotherapy for GI leaks and fistula.Over the scope clips introduced recently, can treat largerdefects compared to through the scope clips. Coveredstents are suited for larger defects and those associatedwith luminal narrowing. However cervical esophagus,gastro-esophageal junction, stomach and right coloniclesions may be better for clip therapy rather thanstenting. Recent developments in this field include use ofendovac therapy which consists of a sponge with suctiondevice, biodegradable stent, use of fibrin glue and someendo-suturing device. Conservative therapy with nosurgical or endoscopic intervention, may be suitablefor a small subset of patients. An algorithm based onlocation, size of defect, associated stricture, infection andavailable expertise needs to be developed to reduce themortality and morbidity of this difficult clinical problem.

关 键 词：FISTULA Leak PERFORATION Post operative Endoscopy Endoscopic Surgery Stent SUTURE ENDOCLIP Clip 

分 类 号：R656[医药卫生—外科学]