Endoskopische Therapieoptionen für Perforationen und Insuffizienzen des Gastrointestinaltrakts

 

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Zusammenfassung

Perforationen und Leckagen von Hohlorganen des Gastrointestinaltrakts können unter Anderem spontan entstehen. Sie können aber auch als Komplikation eines endoskopischen Eingriffes oder nach Anlage einer chirurgischen Anastomose auftreten. Es handelt sich typischerweise um eine schwerwiegende und für den Patienten oft lebensbedrohliche Situation. Klassisch erfolgt die Therapie operativ. Diese Eingriffe sind häufig technisch schwierig und die Morbidität und Letalität auch aufgrund der oft bestehenden lokalen Entzündung nicht zufriedenstellend. In den letzten Jahren wurden verschiedene endoskopische Techniken für die Therapie von Perforationen und Leckagen entwickelt. Dazu zählen vor allem endoskopisch applizierbare Klippsysteme und Stents sowie die relativ neu entwickelten Vakuumsaugdränagen. Insbesondere bei Perforationen der Gallenwege und des Rektum, zunehmend aber auch im Ösophagus, haben diese neuen Techniken trotz oft unzureichender Studiendaten rasch Bedeutung erlangt. Die vorliegende Arbeit gibt anhand der vorhandenen Literatur einen Überblick über die Indikationen und Grenzen der zur Verfügung stehenden endoskopisch-interventionellen Therapieoptionen.

Abstract

Perforations and leakages of hollow organs of the gastrointestinal tract can occur spontaneously among other causes. They can also develop as complications of an endoscopic intervention or after surgical construction of an anastomosis. For the patient, these situations usually are serious and life-threatening. Standard therapy has always been – and most of the time still is – major surgery. These procedures usually are technically difficult and their mortality and morbidity are not satisfactory due to, among others, the occurrence of local infections. Thus, various endoscopic techniques as therapy for perforations and leakages have been developed over the last years. These include above all the endoscopic placement of clip systems and stents and the relatively new vacuum drainage systems. In case of perforations and leakages of the bile duct and the rectum especially, these minimal invasive techniques are widely used, also increasingly in lesions of the esophagus. However, these new, endoscopic procedures suffer from a lack of evidence. This paper highlights the possibilities and limitations of endoscopic options in therapy for perforations and leakages of organs of the gastrointestinal tract.

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