Clinical application of "purse-string suture" under endoscope in the treatment of refractory postoperative intestinal anastomotic fistula.

IF 3.4 2区医学 Q2 ONCOLOGY

BMC Cancer Pub Date : 2025-05-23 DOI:10.1186/s12885-025-14364-w

Guangxu Zhu, Shengjie Zhou, Hongqiao Gao, Shunyao Song, Baoqiang Shan, Youchao Xu, Ningning Sun, Yuanyuan Xu, Shumin Wang, Jianjun Qu, Honglei Gao

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引用次数: 0

Abstract

Background: Postoperative intestinal anastomotic fistula (PIAF) remains a challenging complication with suboptimal outcomes under conventional therapies. This study evaluates the safety and efficacy of endoscopic purse-string suturing (EPS) in managing refractory PIAF and identifies prognostic predictors.

Methods: A retrospective analysis of 55 patients with refractory PIAF treated via EPS (2015-2024) was conducted. Technical success was defined as endoscopic fistula closure, while clinical success required radiologic/endoscopic healing confirmation. Logistic regression models identified risk factors for poor outcomes.

Results: EPS achieved a technical success rate of 87.3% (52/55) and a clinical success rate of 63.6% (35/55). Subgroup analyses revealed no significant differences between in-house and external referrals (clinical: 61.1% vs. 64.9%, P = 0.786; technical: 88.9% vs. 81.1%, P = 0.463). Preoperative ostomy status correlated with higher clinical success (92.3% vs. 54.8%, P = 0.014), though technical success was comparable (92.3% vs. 85.7%, P = 0.533). Multivariate analysis identified delayed intervention (> 2 months post-diagnosis) (OR = 0.027, 95% CI: 0.002-0.410) and Pre-existing anastomotic stricture (OR = 0.43, 95% CI: 0.004-0.507) as independent risk factors for poor prognosis. Complications included anastomotic stricture (3.6%, managed endoscopically) and transient diarrhea (1 case). No mortality or recurrence occurred during 12-month follow-up.

Conclusions: This study establishes endoscopic purse-string closure as a safe and effective minimally invasive intervention for refractory post-implantation anastomotic fistulas, particularly when implemented during early disease progression. Therapeutic optimization through time-sensitive intervention and selective stoma creation demonstrates significant potential for enhancing clinical outcomes in complex fistula management.

查看原文本刊更多论文

内镜下“荷包缝合”治疗难治性术后肠吻合瘘的临床应用。

背景：在常规治疗下，术后肠吻合口瘘（PIAF）仍然是一个具有挑战性的并发症，预后不佳。本研究评估了内镜下荷包缝合（EPS）治疗难治性PIAF的安全性和有效性，并确定了预后预测因素。方法：回顾性分析2015-2024年接受EPS治疗的55例难治性PIAF患者。技术成功定义为内镜下瘘管闭合，而临床成功需要放射/内镜下愈合确认。逻辑回归模型确定了不良结果的风险因素。结果：EPS的技术成功率为87.3%(52/55)，临床成功率为63.6%（35/55）。亚组分析显示，内部转诊和外部转诊之间无显著差异(临床：61.1% vs. 64.9%, P = 0.786；技术：88.9% vs. 81.1%, P = 0.463)。术前造口状态与较高的临床成功率相关（92.3%比54.8%,P = 0.014），尽管技术成功率相当（92.3%比85.7%,P = 0.533）。多因素分析发现延迟干预（诊断后2个月）（OR = 0.027, 95% CI: 0.002-0.410）和既往吻合口狭窄（OR = 0.43, 95% CI: 0.004-0.507）是预后不良的独立危险因素。并发症包括吻合口狭窄（3.6%，内镜下处理）和短暂性腹泻（1例）。随访12个月无死亡或复发。结论：本研究确立了内镜下荷包缝合术是一种安全有效的微创治疗难治性植入术后吻合口瘘的方法，特别是在疾病进展早期实施时。通过时间敏感干预和选择性造口来优化治疗，在复杂瘘管管理中具有显著的提高临床结果的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Cancer 医学-肿瘤学

CiteScore

6.00

自引率

2.60%

发文量

1204

审稿时长

6.8 months

期刊介绍： BMC Cancer is an open access, peer-reviewed journal that considers articles on all aspects of cancer research, including the pathophysiology, prevention, diagnosis and treatment of cancers. The journal welcomes submissions concerning molecular and cellular biology, genetics, epidemiology, and clinical trials.