Endoscopic management of gastrointestinal leaks and fistulae: Whatoption do we have?  

作　　者：Fabrizio Cereatti Roberto Grassia Andrea Drago Clara Benedetta Conti Gianfranco Donatelli 

机构地区：[1]Digestive Endoscopy and Gastroenterology Unit,Cremona Hospital,Cremona,Cremona 26100,Italy [2]Department of Interventional Endoscopy,Hospital Prive Peupliers,Ramsay Santé,Paris 75013,France

出　　处：《World Journal of Gastroenterology》2020年第29期4198-4217,共20页世界胃肠病学杂志（英文版）

摘　　要：Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.

关 键 词：LEAK FISTULA Endotherapy Over-the-scope clip Suturing system Endovacuum therapy Endoscopic internal drainage Self-expandable metal stent 

分 类 号：R57[医药卫生—消化系统]