Gastrointestinal sistemde kanama, perforasyon ve fistüllerde endoskopik klip uygulamaları etkinliği : Tek merkez deneyimi

Amaç: Gastrointestinalsistem kanamaları, perforasyonları ve fistülleri sık karşılaşılan durumlar olmakla birlikte minimal invaziv işlem olarak görülen endoskopik işlemler ile tedavi edilebilmektedir. Over thescope kliplerin (OTSC) kullanıma girmesi ile birlikte işlem başarısı artmakta ve tedavi modalitelerinde ilk basamak olarak kullanımı önerilmektedir. Bu çalışma da literatüre katkı vermeyi ve deneyimlerimizi paylaşmayı amaçlamaktadır. Çalışma Planı: Kliniğimizde 2020 ile 2023 yılları arasında gastrointestinal sistem perforasyonları, anastomozkaçakları, fistülleri,kanamaları ve endomukozal rezeksiyon sonrası endoskopik klip uygulaması yapılan 21 hasta değerlendirildi. Bulgular: Çalışmamıza 13 erkek (%61,9) olmak üzere toplam 21 hasta dahil edildi. Kanama grubunda 16, anatomoz kaçağı grubunda bir, fistül grubunda bir, endomukozal rezeksiyon grubunda üç hasta vardı.Kanama grubundahiçbir hastada başarısızlık görülmedi. Antitrombotik ilaç kullanımı başarıyı değiştirmemekteydi. Cerrahi işlem gerekliliği olmadı. 30 günlük takipte ise sadece bir hastada(%6,25) tekrar kanama ve yeniden işlem gerekliliği oldu. Endomukozal rezeksiyon, fistül ve anastomoz kaçağında uygulanan kliplerin işlemlerinde herhangi bir komplikasyon takibimizde saptanmadı. Uygulanan eritrosit süspansiyonu replasmanı ile hastanede yatış süresi arasında pozitif yönde korelasyon mevcuttu (p<0.001; p=0,897). Ancak kullanılan klip sayısı ile hastanede yatış süresi arasında anlamlı ilişki saptanmadı (p=0,451). Sonuç: Alt ve üst gastrointestinal sistem kanamalarında, anastomoz kaçaklarında, fistüllerinde ve endomukozal rezeksiyon sonrası perforasyonlarda over the scope kliplerin kullanımı güvenli ve başarılıdır.

Anahtar Kelimeler:

Gastrointestinal sistem, Kanama, Perforasyon, Fistül, klip

Efficacy of the endoscopic clip method in patients treated with the endoscopic clip method for gastrointestinal bleeding, perforations and fistulas : One Center Experience

Introduction:Gastrointestinal bleeding, perforations and fistulas are common conditions and can betreated with endoscopic procedures that are considered as minimally invasive procedures. With theintroduction of ovarian thescope clips (OTSC), the success of the procedure is increasing and its use isrecommended as the first step in treatment modalities. This study aims to contribute to the literatüre and share our experiences. Methods:Between 2020 and 2023, 21 patients who underwent endoscopic clipapplication after gastrointestinal tract perforations, anastomotic leaks, fistulas, bleeding andendomucosal resection in our clinic were evaluated. Results:A total of 21 patients, 13 males (61.9%), were included in our study. There were 16 patientsin the bleeding group, one in the anatomical leak group, one in the fistula group and three in theendomucosal resection group. No failure was seen in any patient in the bleeding group.Antithrombotic drug use did not change the success. No surgical procedure was required. At 30-dayfollow-up, only one patient (6.25%) had rebleeding and required reoperation. No complications weredetected in the procedures of endomucosal resection, fistula and clips applied in anastomotic leakage.There was a positive correlation between erythrocyte suspension replacement and length ofhospitalization (p<0.001; p=0.897). However, there was no significant correlation between thenumber of clips used and the duration of hospitalization (p=0.451). Conclusion:The use of over the scope clips is safe and successful in upper and lower gastrointestinaltract bleeding, gastrointestinal tract anastomotic leaks, fistulas and perforations after endomucosalresection.

Keywords:

Gastrointestinal tract, bleeding, perforation, fistula, clip,

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