内镜性阴性食道穿孔和管理:现代时代的回顾性结果分析
Eric M Montminy1, Blake Jones1, J Christie Heller2
1Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, 80045, USA.
BMC gastroenterology
|November 1, 2023
概括
阳性食道穿孔 (IEP) 是上部内镜手术过程中罕见的不良事件. 大多数IEP都能成功地通过内分泌疗法治疗,导致低死亡率.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 不良事件管理管理不良事件管理
背景情况:
- 阳性食道穿孔 (IEP) 是上部内镜手术 (UEP) 的严重并发症.
- 管理策略已经从手术演变为不那么侵入性的内科疗法,如剪贴关闭 (CC),自扩张金属支架 (SEMS) 和真空疗法 (VT).
- 有限的数据存在于当代干预内镜实践期间的结果.
研究的目的:
- 为了追溯分析在干预内镜的当代时期管理的阳性食道穿孔 (IEPs) 的结果.
- 评估不同管理策略的有效性,包括内疗和手术.
主要方法:
- 从2011年1月到2023年12月,在3所学术医院对32例阳性食道穿孔 (IEP) 的回顾性审查.
- 数据从集中的不良事件 (AE) 数据库和患者医疗记录中收集.
- 使用微软Excel和STATA进行的统计分析.
主要成果:
- 大多数IEP发生在扩张或异物清除后,主要发生在食道下部或胃食道结处.
- 诊断是通过内镜,CT或食道镜在平均2小时内进行的.
- 终极疗法 (CC,SEMS) 是主要治疗方法,2013年以后不需要进行外科手术;中位数住院时间为3天,死亡率为12.5%.
结论:
- 阴性食道穿孔 (IEP) 是上部内镜手术 (UEP) 的罕见并发症.
- 当代管理主要涉及内疗,很少需要手术.
- 向内分泌疗法的转变有助于有利的结果和低死亡率.
相关概念视频
Esophageal Perforation-II: Clinical Manifestations and Management
69
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
69
Esophageal Perforation-I: Introduction
101
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
101
Esophageal Strictures-II: Clinical Features and Management
77
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
77
Esophageal Strictures-I: Introduction
112
Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
112
Inflammatory Bowel Disease V: Surgical Management
149
Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
Here are some common surgical interventions for IBD:
149
Barrett Esophagus-II: Clinical Manifestations and Management
164
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
164


