Endoskopische Therapie der Ösophagusleckage

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

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