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DOI: 10.1055/s-0041-100382
Endoskopie beim postoperativen Komplikationsmanagement
Teil 1: Drainage, Stent, Clip und SchwammPublication History
Publication Date:
19 June 2015 (online)
![](https://www.thieme-connect.de/media/avc-u2d/201503/lookinside/thumbnails/10-1055-s-0041-100382_av199_kantowski-1.jpg)
Die flexible Endoskopie hat beim Auftreten von postoperativen Komplikationen wie einer Anastomosenleckage im Gastrointestinaltrakt in den letzten Jahren einen starken Wandel in der Therapie bewirkt. Die Entwicklung geht von der rein diagnostischen Endoskopie mit anschließender Re-Operation oder radiologischer Abszessdrainage immer mehr hin zu verschiedenen Methoden der interventionellen Endoskopie.
In diesem 1. Teil des Beitrags werden das diagnostische Vorgehen bei V. a. Anastomosenleckage sowie die folgenden endoskopischen Methoden zur Abdichtung der Leckage und Abszessdrainage beschrieben:
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Clip
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Stent
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Vakuummethode
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Platzierung des Schwamms mit Schleppfaden
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Platzierung mit der Zange
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Platzierung via Draht
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Durchzugmethode
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Platzierung via PEG
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Literatur
- 1 Iannettoni MD, Whyte RI, Orringer MB. Catastrophic complications of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg 1995; 110: 1493-1500
- 2 Sharma A, Deeb AP, Rickles AS et al. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis 2013; 15: 458-462
- 3 Karliczek A, Jesus EC, Matos D et al. Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis 2006; 8: 259-265
- 4 Kessler H, Hermanek jr. P, Wiebelt H. Operative mortality in carcinoma of the rectum. Results of the German Multicentre Study. Int J Colorectal Dis 1993; 8: 158-166
- 5 Cong ZJ, Fu CG, Wang HT et al. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg 2009; 33: 1292-1297
- 6 Farke S, Gögler H. Anastomoseninsuffizienz nach kontinenzerhaltenden Rektumresektionen. Coloproctology 2000; 15: 161-169
- 7 Siewert JR, Stein HJ, Bartels H. Anastomotic leaks in the upper gastrointestinal tract. Chirurg 2004; 75: 1063-1070
- 8 Alves A, Panis Y, Pocard M et al. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999; 189: 554-559
- 9 Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 1999; 229: 174-180
- 10 Daams F, Wu Z. , Lahaye MJ et al. Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature. World J Gastrointest Surg 2014; 6: 14-26
- 11 Sauvanet A, Baltar J, Le Mee J et al. Diagnosis and conservative management of intrathoracic leakage after oesophagectomy. Br J Surg 1998; 85: 1446-1449
- 12 Ortega-Deballon P, Radais F, Facy O et al. C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg 2010; 34: 808-814
- 13 Doeksen A, Tanis PJ, Wüst AF et al. Radiological evaluation of colorectal anastomoses. Int J Colorectal Dis 2008; 23: 863-868
- 14 Doerfer J, Meyer T, Klein P et al. The importance of radiological controls of anastomoses after upper gastrointestinal tract surgery – a retrospective cohort study. Patient Saf Surg 2010; 4: 17
- 15 Grund KE, Stüker D. Diagnostik der Nahtinsuffizienz im Gastrointestinaltrakt „Suffizienz“ von Radiologie und Endoskopie. Kongressbericht. Langenbecks Archiv Chir Supp II 1998; 1146-1149
- 16 Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg 2004; 16: 124-132
- 17 Jiang F, Yu MF, Ren BH et al. Nasogastric placement of sump tube through the leak for the treatment of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. J Surg Res 2011; 171: 448-451
- 18 Lee DH, Kim HR, Kim SR et al. Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer. Dis Esophagus 2013; 26: 609-615
- 19 Cellier C, Landi B, Faye A et al. Upper gastrointestinal tract fistulae: endoscopic obliteration with fibrin sealant. Gastrointest Endosc 1996; 44: 731-733
- 20 Groitel H, Horbach T. Endoscopic treatment of anastomotic insufficiency perforations in the oesophagus with fibrin glue. Langenbecks Arch Chir Suppl Kongressbd 1996; 113: 753-754
- 21 Truong S, Bohm G, Klinge U et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc 2004; 18: 1105-1108
- 22 Changela K, Virk MA, Patel N et al. Role over the scope clips in the management of iatrogenic gastrointestinal perforations. World J Gastroenterol 2014; 20: 11460-11462
- 23 Jayaraman V, Hammerle C, Lo SK et al. Clinical application and outcomes of over the scope clip device: initial US experience in humans. Diagn Ther Endosc 2013; 2013: 183-187
- 24 Lee WC, Ko WJ, Cho JH et al. Endoscopic treatment of various gastrointestinal tract defects with an over-the-scope clip: case series from a tertiary referral hospital. Clin Endosc 2014; 47: 178-182
- 25 Sulz MC, Bertolini R, Frei R et al. Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: Swiss experience in a tertiary center. World J Gastroenterol 2014; 20: 16287-16292
- 26 Kirschniak A, Subotova N, Zieker D et al. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011; 25: 2901-2905
- 27 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; 28: 1703-1711
- 28 van Boeckel PG, Dua KS, Weusten BL et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 2012; 12: 19
- 29 Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg 2014; 208: 536-543
- 30 Grund KE, Stüker D. Stentextraktion im GIT. Endo heute 2009; 22: 222-226
- 31 Grund KE, Farin G, Ingenpaß R. Stententfernung: Leichter gesagt als getan. Teil 1. Endo-Praxis 2010; 26: 10-25
- 32 Grund KE, Ingenpaß R, Farin G et al. Stententfernung: Leichter gesagt als getan. Teil 2. Endo-Praxis 2010; 26: 54-61
- 33 Weidenhagen R, Hartl WH, Gruetzner KU et al. Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg 2010; 90: 1674-1681
- 34 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; 5: 340-345
- 35 Wedemeyer J, Brangewitz M, Kubicka S et al. Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system. Gastrointest Endosc 2010; 71: 382-386
- 36 Bludau M, Hölscher AH, Herbold T et al. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc 2014; 28: 896-901
- 37 Weidenhagen R, Grützner KU, Kopp R et al. Role of vacuum therapy in the management of the septic abdomen. Zentralbl Chir 2006; 131 (Suppl. 01) 115-119
- 38 Schorsch T, Müller C, Loske G. Endoscopic vacuum therapy of perforations and anastomotic insufficiency of the esophagus. Chirurg 2014; 85: 1081-1093
- 39 Loske G, Strauss T, Riefel B et al. Endoscopic vacuum therapy in the management of anastomotic insufficiency after pancreaticoduodenectomy. Endoscopy 2012; 44 (Suppl. 02) E94-95
- 40 Fischer A, Baier PK, Hopt UT et al. Laparoendoscopic mediastinal vacuum therapy of a gastric perforation through the diaphragm. Endoscopy 2011; 43 (Suppl. 02) E393-E394
- 41 Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 1995; 169: 634-640