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

• 作者: Eric M Pauli. Joshua S Winder
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: PERFORATION FISTULA Anastomotic LEAK Overthe scope CLIPS Overstitch STENT Endoscopic
• 年，卷（期）: 2015,（8）
• 页码范围: 758-768
• 页数: 11页
• 分类号: R

摘要

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.