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Endoskopie heute 2014; 27(1): 17-21
DOI: 10.1055/s-0034-1366189
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Endoskopische Therapie der Ösophagusleckage

Endoscopic Treatment of Esophageal Leakages
J. Wedemeyer
1   Medizinische Klinik I, Schwerpunkt Gastroenterologie und Hepatologie, KRH Klinikum Robert Koch Gehrden
,
M. Memming
2   Allgemein-, Viszeral- und Gefäßchirurgie, KRH Klinikum Robert Koch Gehrden
,
M. Schmidt
1   Medizinische Klinik I, Schwerpunkt Gastroenterologie und Hepatologie, KRH Klinikum Robert Koch Gehrden
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
17. März 2014 (online)

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Zusammenfassung

Anastomosenleckagen stellen eine gefürchtete Komplikation nach Operationen am oberen Gastrointestinaltrakt dar, die mit hoher Morbidität und Mortalität vergesellschaftet sind. Die Behandlungsstrategien haben sich in den letzten Jahren deutlich gewandelt. Die endoskopische Therapie hat die chirurgische Revisionsoperation fast völlig verdrängen können. Die Einlage komplett beschichteter Stents stellt die am häufigsten eingesetzte Methode zur Behandlung ösophagealer Leckagen dar. Eine neue endoskopische Therapiemodalität stellt die endoskopische Vakuumschwammtherapie dar. Hierbei macht man sich die positiven Effekte des vakuumassistierten Verschlusses (Vacuum Assisted Closure, V.A.C) zu nutzen, der eine etablierte Therapiemodalität zur Behandlung ausgedehnter infizierter Hautdefekte darstellt. Durch neue Entwicklungen haben auch Clips (insbesondere der „Over The Scope Clip“, OTSC) wieder eine Bedeutung im Verschluss ösophagealer Nahtinsuffizienzen erhalten. Eine umfangreiche Kenntnis der Vor- und Nachteile der unterschiedlichen Methode und der postoperativen Anatomie ist die Voraussetzung für eine differenzierte, optimale, endoskopische Therapie.

Abstract

Postsurgical leakages after resections of the esophagus are associated with high morbidity and mortality. Endoscopic therapy has gained increasingly acceptance and has almost completely replaced surgical revision. Placement of self expanding stents is the best established endoscopic treatment option for esophageal leakages. A new development is the endoscopic placement of vacuum sponge systems. Which have been adapted from VAC therapy for extensive infected skin defects. The development of over the scope clips (OTSC) provides another endoscopic treatment modality for esophageal leaks. Comprehensive knowledge of the various methods and their advantages as well as their limitations and drawbacks is necessary to provide optimal endoscopic care in these critically situations.

Schlüsselwörter

Endo-VAC - selbstexpandierender Stent - Ösophagus - Anastomosenleckage - OTSC

Key words

Endo-VAC - selfexpanding stent - esophagus - anastomotic leakage - OTSC
 

  • Literatur

  • 1 Briel JW, Tamhankar AP, Hagen JA et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 2004; 198: 536-541
    CrossrefPubMedGoogle Scholar
  • 2 Hunerbein M, Stroszczynski C, Moesta KT et al. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 2004; 240: 801-807
    CrossrefPubMedGoogle Scholar
  • 3 Doniec JM, Schniewind B, Kahlke V et al. Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy 2003; 35: 652-658
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Langer FB, Wenzl E, Prager G et al. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 2005; 79: 398-403
    CrossrefPubMedGoogle Scholar
  • 5 Dai YY, Gretschel S, Dudeck O et al. Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents. Br J Surg 2009; 96: 887-891
    CrossrefPubMedGoogle Scholar
  • 6 David EA, Kim MP, Blackmon SH. Esophageal salvage with removable covered self-expanding metal stents in the setting of intrathoracic esophageal leakage. Am J Surg 2011; 202: 796-801
    CrossrefPubMedGoogle Scholar
  • 7 Wilson JL, Louie BE, Farivar AS et al. Fully covered self-expanding metal stents are effective for benign esophagogastric disruptions and strictures. J Gastrointest Surg 2013; 17: 2045-2050
    CrossrefPubMedGoogle Scholar
  • 8 Brangewitz M, Voigtländer T, Helfritz FA et al. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy 2013; 45: 433-438
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Gubler C, Bauerfeind P. Self-expandable stents for benign esophageal leakages and perforations: long-term single-center experience. Scand J Gastroenterol 2014; 49: 23-29
    CrossrefPubMedGoogle Scholar
  • 10 El Hajj II, Imperiale TF, Rex DK et al. Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc 2013; Epub ahead of print
    PubMedGoogle Scholar
  • 11 Hoeppner J, Kulemann B, Seifert G et al. Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses. Surg Endosc 2014; Epub ahead of print
    PubMedGoogle Scholar
  • 12 Böhm G, Mossdorf A, Klink C et al. Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue. Endoscopy 2010; 42: 599-602
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 13 Schorsch T, Müller C, Loske G. Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc 2013; 27: 2040-2045
    CrossrefPubMedGoogle Scholar
  • 14 Schniewind B, Schafmayer C, Voehrs G. Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc 2013; 27: 3883-3890
    CrossrefPubMedGoogle Scholar
  • 15 Bludau M, Hölscher AH, Herbold T. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc 2013; Epub ahead of print
    PubMedGoogle Scholar
  • 16 Heits N, Stapel L, Reichert B et al. Endoscopic Endoluminal Vacuum Therapy in Esophageal Perforation. Ann Thorac Surg 2014; ; Jan 18. pii: S0003–4975 (13) 02576-9. doi: 10.1016/j.athoracsur. 2013.11.014. [Epub ahead of print]
    PubMedGoogle Scholar
  • 17 Weiland T, Fehlker M, Gottwald T et al. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27 (07) 2258-2274
    CrossrefPubMedGoogle Scholar
  • 18 Pohl J, Borgulya M, Lorenz D et al. Endoscopic closure of postoperative esophageal leaks with a novel over-the scope-Clip system. Endoscopy 2010; 42: 757-759
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Holle G, Riedel K, von Gregory H et al. Vacuum-assisted closure therapy: Current status and basic research. Unfallchirurg 2007; 110: 490-504
    CrossrefPubMedGoogle Scholar
  • 20 Weidenhagen R, Gruetzner KU, Wiecken T et al. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008; 22: 1818-1825
    Google Scholar
  • 21 Fähndrich M, Sandmann M, Heike M. Removal of over the scope clips (OTSC) with an Nd:YAG Laser. Z Gastroenterol 2011; 49: 579-583
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Lenzen H, Negm AA, Erichsen TJ et al. Successful treatment of cervical esophageal leakage by endoscopic-vacuum assisted closure therapy. World J Gastrointest Endosc 2013; 16: 340-345
    PubMedGoogle Scholar