Endoskopische Therapie von Leckagen im Gastrointestinaltrakt, an den Gallenwegen und im Pankreas

M. Wettstein; T. Frieling; R. Lüthen; T. Heintges; C. Niederau; M. Oette; C. Vogt; S. vom Dahl

doi:10.1055/s-0031-1273422

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2011; 49(6): 740-748
DOI: 10.1055/s-0031-1273422

Übersicht

Endoskopische Therapie von Leckagen im Gastrointestinaltrakt, an den Gallenwegen und im Pankreas

Endoscopic Therapy for Leaks in the Gastrointestinal Tract, the Bile Ducts and the PancreasM. Wettstein¹ , T. Frieling² , R. Lüthen³ , T. Heintges⁴ , C. Niederau⁵ , M. Oette⁶ , C. Vogt⁷ , S. vom Dahl⁸

¹I. Medizinische Klinik, Klinikum Passau
²Medizinische Klinik II, Helios Klinikum Krefeld
³Klinik für Innere Medizin, Marien Hospital Düsseldorf
⁴Medizinische Klinik II, Städtische Kliniken Neuss-Lukaskrankenhaus
⁵Klinik für Innere Medizin, Katholische Kliniken Oberhausen
⁶Klinik für Allgemeine Innere Medizin, Krankenhaus der Augustinerinnen, Köln
⁷Abteilung Innere Medizin, St. Josef-Krankenhaus Moers
⁸Klinik für Innere Medizin, St. Franziskus-Hospital Köln

Abstract

Zusammenfassung

Die Therapie von Perforationen, Leckagen und Fisteln im Gastrointestinaltrakt war früher eine Domäne der Chirurgie. Heute ist in vielen Fällen eine weniger invasive endoskopische Therapie möglich. Der Endoskopiker hat die Möglichkeit, Perforationen als Folge endoskopischer Untersuchungen, Bougierungen und Resektionen während des Eingriffs unmittelbar zu verschließen. Im Ösophagus ist die effektive Therapie von Perforationen und Anastomoseninsuffizienzen durch die temporäre Platzierung von gecoverten Stents gut etabliert. Mit herkömmlichen Metallclips lassen sich kleinere Leckagen und Fisteln im Ösophagus und Magen-Darm-Trakt verschließen. Die seit Kurzem verfügbaren Over-the-scope-Clips und spezielle Fasszangen und Anker ermöglichen einen sichereren Vollwandverschluss im oberen Gastrointestinaltrakt und im Rektosigmoid. Die endoskopisch geführte Vakuum-Schwammtherapie ist bei rektalen Anastomoseninsuffizienzen etabliert und wird zunehmend auch bei Leckagen im Bereich des Ösophagus eingesetzt. Bei Gallenwegsleckagen nach endoskopischen oder chirurgischen Gallenwegseingriffen reicht meist die effektive interne Galleableitung mittels temporärem Stenting des Gallengangs aus. In einigen Fällen ist ein Verschluss durch gecoverte Metallstents oder mittels Coils erforderlich. Pankreasleckagen stellen ein therapeutisches Problem dar und können multimodale Therapien mit Stenting, Verklebung und Coils erforderlich machen.

Abstract

Surgery has been the mainstay of therapy in patients with gastrointestinal perforations, leakage or fistulas. New techniques for endoscopic closure of gastrointestinal perforations provide tools for an effective treatment by less invasive procedures. Temporary placement of covered self-expanding stents is an established therapy for oesophageal perforations and anastomotic leaks. Using conventional endoclips small perforations and leaks in the oesophagus and gastrointestinal tract may be closed. With the new over-the-scope-clips a more effective endoscopic full wall closure is possible in the upper gastrointestinal tract and the rectum. Endoscopically guided endoluminal vacuum therapy using polyurethane sponges is an established method for treating rectal leaks and is now increasingly used also in oesophageal leaks. Biliary leakage following endoscopic or surgical interventions is effectively treated with temporary bile stenting in most cases, but closure using metal stents or coiling may be necessary. Pancreatic leaks are a major therapeutic problem and may require multimodal therapies.

Schlüsselwörter

Perforationen - Anastomoseninsuffizienzen - endoskopische Behandlung - Over-the-scope-Clips - Vakuum-Schwammtherapie - Stenting

Key words

perforations - anastomotic leaks - endoscopic treatment - over-the-scope-clip - stenting

Full Text

References

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Prof. Dr. Matthias Wettstein

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