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Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

机译：结肠直肠手术的早期吻合并发症：对内窥镜挽救技术的系统综述

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BackgroundAnastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.MethodA literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string colorectal anastomotic (leak OR bleed), endoscopy, endoscopic management. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.ResultsA total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.ConclusionEndoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.
机译：结直肠手术后的BackgroundAastomotic并发症与显着的发病率和死亡率有关。对于缺乏或控制的系统脓毒症的患者，越来越多地采用最小的或受控制的良好控制，例如内窥镜疗法，以降低手术再干预的发病率。在本综述中，我们的目标是评估内窥镜管理在结肠直肠吻合术并发症的急性设定中的效用，重点涉及吻合泄漏。使用搜索条件字符串使用PubMed，Cochrane和Scopus数据库发布的全文文章进行了文献搜索结肠直肠吻合口（泄漏或漏），内窥镜检查，内窥镜管理。通过扫描相关论文的参考来检测额外的纸张。通过两位作者从每次研究中提取数据，进入专用的Pro-Forma。鉴于提取的数据的性质，未进行META分析。确定了89篇论文的总共，其中16个被列入本综述;从参考搜查中获得另外14篇论文。在没有生理损害的患者中，有关于支架的救生率，过度范围内窥镜夹，真空治疗和纤维蛋白胶水在结肠直肠吻合泄漏的早期管理中有前途的数据。对于最佳方法没有达成共识，并且缺乏帮助医生的数据。虽然有关救赎的数据（即愈合和避免手术）良好，但没有报道有关功能结果的数据。结论稳定患者的稳定患者的稳定性吻合泄漏的管理似乎安全，在选定的患者中，患者有关的技术成功率高有关。挑战仍在选择最合适的策略，患者选择，理解这种方法的功能和长期后遗症。需要大型预期队列研究的进一步证据进一步评估这些新颖策略的作用。

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