Liječenje oštećenja probavne cijevi primjenom endoskopske stezaljke: prikaz serije bolesnika [The over-the-scope-clip for the treatment of the digestive tube leaks and tears: a case-series]

Iveković, Hrvoje and Brljak, Jadranka and Bilić, Branko and Markoš, Pave and Pulanić, Roland and Ostojić, Rajko and Rustemović, Nadan (2016) Liječenje oštećenja probavne cijevi primjenom endoskopske stezaljke: prikaz serije bolesnika [The over-the-scope-clip for the treatment of the digestive tube leaks and tears: a case-series]. Liječnički vjesnik, 138 (3-4). pp. 79-84. ISSN 0024-3477

PDF - Published Version Download (894kB)

Abstract

Digestive tube damages represent a therapeutic challenge for the gastrointestinal endoscopists. Recenty, a novel device – the-over-the-scope clip (OTSC) – has been introduced for non-surgical treatment of gastrointestinal perforations, fi stula, anastomotic leaks and refractory gastrointestinal bleeds. This study aimed to evaluate the therapeutic effi cacy of OTSC in our case series. A total of nine patients were included (six males, medain age 72 years, range 58-86). The indications were upper gastrointestinal bleeding (refractory to standard endoscopic treatment: fi ve patients, a vessel with a large caliber: one patient), fi stula in two patients, and iatrogenic perforation of the sigmoid colon in one patient. Atraumatic and traumatic versions of OTSCs with twin graspers were used. All of the patients were treated with only one OTSC, and none of the patients required additional endoscopic treatment. The OTSC procedure had 100% technical success. In a subgroup of patients with perforation and fi stulae, the clinical success was 67%, whereas in those with the bleedings it was 50%. The median follow-up was 34 days (range: 3-452). OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic effi cacy was subopimal in patients with the upper gastrointestinal bleedings possibly due to the application of the sharp-teeth OTSC.

Abstract in Croatian

Oštećenja probavne cijevi terapijski su izazov za liječnike koji se bave gastrointestinalnom endoskopijom. Nedavno je u kliničku praksu uvedena endoskopska stezaljka za nekirurško liječenje fistula, perforacija, anastomotskih propuštanja i refraktornih krvarenja. U članku prikazujemo iskustva o primjeni stezaljke u našoj seriji bolesnika. Endo­skopska stezaljka primijenjena je kod devet ispitanika (šest muškaraca, tri žene, medijan dobi 72 godine, raspon 58 – 86 godina). Indikacije za primjenu stezaljke uključivale su: krvarenje iz gornjeg dijela probavne cijevi (neuspjeh endoskopske hemostaze kod pet ispitanika te velik promjer krvne žile kod jednog ispitanika), endoskopsko liječenje fistula probavne cijevi kod dva ispitanika te liječenje ijatrogene perforacije sigme kod jednog ispitanika. Upotrebljavane su stezaljke s oštrim i tupim zupcima i dvostruki hvatač. Kod svih ispitanika iskorištena je samo jedna stezaljka i nije se rabila dodatna endoskopska terapija. Registrirana je 100%-tna tehnička primjena stezaljke. U podgrupi bolesnika s krvarenjima klinički uspjeh iznosio je 50%, a kod ispitanika s perforacijama i fistulama 67%. Prosječno vrijeme praćenja bolesnika bilo je 34 dana (raspon 3 – 452). Endoskopska stezaljka siguran je i učinkovit pribor za endoskopsko liječenje oštećenja probavne cijevi. Ipak, klinički uspjeh procedure bio je manji u podgrupi bolesnika s krvarenjem iz gornjeg dijela probavne cijevi, uglavnom zbog primjene stezaljki s oštrim zupcima.

Actions (login required)

View Item

Downloads