Comprehensive management of full-thickness luminal defects: The next frontier of gastrointestinal endoscopy  

作　　者：Joshua S Winder Eric M Pauli 

机构地区：[1]Penn State Milton S. Hershey Medical Center

出　　处：《World Journal of Gastrointestinal Endoscopy》2015年第8期758-768,共11页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：Full thickness gastrointestinal defects such as perforations, leaks, and fistulae are a relatively common result of many of the endoscopic and surgical procedures performed in modern health care. As the number of these procedures increases, so too will the number of resultant defects. Historically, these were all treated by open surgical means with the associated morbidity and mortality. With the recent advent of advanced endoscopic techniques, these defects can be treated definitively while avoiding an open surgical procedure. Here we explore the various techniques and tools that are currently available for the treatment of gastrointestinal defects including through the scope clips, endoscopic suturing devices, over the scope clips, sealants, endoluminal stents, endoscopic suction devices, and fistula plugs. As fistulae represent the most recalcitrant of defects, we focus this editorial on a multimodal approach of treatment. This includes optimization of nutrition, treatment of infection, ablation of tracts, removal of foreign bodies, and treatment of distal obstructions. We believe that by addressing all of these factors at the time of attempted closure, the patient is optimized and has the best chance at longterm closure. However, even with all of these factors addressed, failure does occur and in those cases, endoscopic therapies may still play a role in that they allow the patient to avoid a definitive surgical therapy for a time while nutrition is optimized, and infections are addressed.Full thickness gastrointestinal defects such as perforations,leaks, and fistulae are a relatively commonresult of many of the endoscopic and surgical proceduresperformed in modern health care. As thenumber of these procedures increases, so too will thenumber of resultant defects. Historically, these wereall treated by open surgical means with the associatedmorbidity and mortality. With the recent advent ofadvanced endoscopic techniques, these defects canbe treated definitively while avoiding an open surgicalprocedure. Here we explore the various techniquesand tools that are currently available for the treatmentof gastrointestinal defects including through the scopeclips, endoscopic suturing devices, over the scopeclips, sealants, endoluminal stents, endoscopic suctiondevices, and fistula plugs. As fistulae represent themost recalcitrant of defects, we focus this editorial ona multimodal approach of treatment. This includesoptimization of nutrition, treatment of infection, ablationof tracts, removal of foreign bodies, and treatment ofdistal obstructions. We believe that by addressing allof these factors at the time of attempted closure, thepatient is optimized and has the best chance at longtermclosure. However, even with all of these factorsaddressed, failure does occur and in those cases, endoscopictherapies may still play a role in that they allowthe patient to avoid a definitive surgical therapy fora time while nutrition is optimized, and infections areaddressed.

关 键 词：PERFORATION FISTULA Anastomotic LEAK Overthe scope CLIPS Overstitch Stent Endoscopic 

分 类 号：R656[医药卫生—外科学]