食道破裂に対する内視鏡治療の可能性
食道破裂に対する治療法に関するコンセンサスは得られていない。手術不能症例は保存的加療が行われるが，治療過程で食道難治性瘻孔となることが多い。難治性瘻孔の治療として生体接着剤を用いた瘻孔充填術の報告が散見される。私達は食道破裂後瘻孔に対するalpha-cyanoacrylate monomer（A-CA）を用いた内視鏡下瘻孔閉鎖術を行い良好な結果を得ている。具体的には透視下内視鏡的に瘻孔内にリピオドール1.7mLとA-CA 0.3mLを混合した塞栓剤を注入する手技である。これまで交通外傷後の食道穿孔1例，食道癌術後の食道瘻孔2例，食道切除後の再建結腸胸腔内穿破1例に本内視鏡治療を行い，全例治癒し...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 35; no. 1; pp. 079 - 084 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2015
Japanese Society for Abdominal Emergency Medicine |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.35.079 |
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| Abstract | 食道破裂に対する治療法に関するコンセンサスは得られていない。手術不能症例は保存的加療が行われるが，治療過程で食道難治性瘻孔となることが多い。難治性瘻孔の治療として生体接着剤を用いた瘻孔充填術の報告が散見される。私達は食道破裂後瘻孔に対するalpha-cyanoacrylate monomer（A-CA）を用いた内視鏡下瘻孔閉鎖術を行い良好な結果を得ている。具体的には透視下内視鏡的に瘻孔内にリピオドール1.7mLとA-CA 0.3mLを混合した塞栓剤を注入する手技である。これまで交通外傷後の食道穿孔1例，食道癌術後の食道瘻孔2例，食道切除後の再建結腸胸腔内穿破1例に本内視鏡治療を行い，全例治癒している。本内視鏡治療は低侵襲の面で推奨される治療法である。しかし，このような内視鏡治療の適応規準や内視鏡治療の限界は明らかにされておらず，今後さらに症例を積み重ねて検証していく必要がある。 |
|---|---|
| AbstractList | The application of glue is an established treatment for fistulas. We consider that the alpha-cyanoacrylate monomer (α-CA) is ideal for glue embolization in the case of intractable esophageal fistulas, because α-CA glue spreads faster and thus creates a bond more rapidly than the other polymer glues. However, there have been few reports of successful fistula closure using α-CA glue. We herein present four cases with intractable esophageal fistulas that were successfully treated with endoscopic injection of α-CA. One patient developed an aortoesophageal fistula due to a traffic accident. Two patients developed anastomotic leakage after esophagectomy for esophageal cancer. The other patient experienced perforation of a colon conduit after esophagectomy for esophageal cancer. In the image-guided therapy suite, a mixture of α-CA and lipiodol at a ratio of 0.3 to 1.7 mL was endoscopically injected through the fistula using a dispersion tube and a 2.5 mL glue syringe. We repeated this procedure every one or two weeks until the fistula was closed. In all four patients, esophageal fistulas were successfully closed with endoscopic injection of α-CA. This method is a feasible and safe procedure that may be effective for the treatment of non-healing esophageal fistulas.
食道破裂に対する治療法に関するコンセンサスは得られていない。手術不能症例は保存的加療が行われるが，治療過程で食道難治性瘻孔となることが多い。難治性瘻孔の治療として生体接着剤を用いた瘻孔充填術の報告が散見される。私達は食道破裂後瘻孔に対するalpha-cyanoacrylate monomer（A-CA）を用いた内視鏡下瘻孔閉鎖術を行い良好な結果を得ている。具体的には透視下内視鏡的に瘻孔内にリピオドール1.7mLとA-CA 0.3mLを混合した塞栓剤を注入する手技である。これまで交通外傷後の食道穿孔1例，食道癌術後の食道瘻孔2例，食道切除後の再建結腸胸腔内穿破1例に本内視鏡治療を行い，全例治癒している。本内視鏡治療は低侵襲の面で推奨される治療法である。しかし，このような内視鏡治療の適応規準や内視鏡治療の限界は明らかにされておらず，今後さらに症例を積み重ねて検証していく必要がある。 食道破裂に対する治療法に関するコンセンサスは得られていない。手術不能症例は保存的加療が行われるが，治療過程で食道難治性瘻孔となることが多い。難治性瘻孔の治療として生体接着剤を用いた瘻孔充填術の報告が散見される。私達は食道破裂後瘻孔に対するalpha-cyanoacrylate monomer（A-CA）を用いた内視鏡下瘻孔閉鎖術を行い良好な結果を得ている。具体的には透視下内視鏡的に瘻孔内にリピオドール1.7mLとA-CA 0.3mLを混合した塞栓剤を注入する手技である。これまで交通外傷後の食道穿孔1例，食道癌術後の食道瘻孔2例，食道切除後の再建結腸胸腔内穿破1例に本内視鏡治療を行い，全例治癒している。本内視鏡治療は低侵襲の面で推奨される治療法である。しかし，このような内視鏡治療の適応規準や内視鏡治療の限界は明らかにされておらず，今後さらに症例を積み重ねて検証していく必要がある。 |
| Author | 勝田, 将裕 早田, 啓治 中森, 幹人 尾島, 敏康 中村, 公紀 山上, 裕機 |
| Author_FL | Ojima Toshiyasu Nakamura Masaki Katsuda Masahiro Nakamori Mikihito Hayata Keiji Yamaue Hiroki |
| Author_FL_xml | – sequence: 1 fullname: Ojima Toshiyasu – sequence: 2 fullname: Nakamori Mikihito – sequence: 3 fullname: Nakamura Masaki – sequence: 4 fullname: Katsuda Masahiro – sequence: 5 fullname: Hayata Keiji – sequence: 6 fullname: Yamaue Hiroki |
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| Copyright | 2014, Japanese Society for Abdominal Emargency Medicine |
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| References | 8) Iwata T, Chung K, Toda M, et al: Malignant esophagobronchial fistula with severe esophageal stenosis, successfully treated by transbronchial occlusion with cyanoacrylate glue. Endoscopy 2012; 44: E317-318. 5) Bège T, Emungania O, Vitton V, et al: An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc 2011; 73: 238-244. 2) Barthelemy C, Audigier JC, Fraisse H: A non-tumoral esophago-bronchial fistula managed by isobutyl-2-cyanoacrylate. Endoscopy 1983; 15: 357-358. 4) Melmed GY, Kar S, Geft I, Lo SK: A new method for endoscopic closure of gastrocolonicfistula: novel application of a cardiac septal defect closure device (with video). Gastrointest Endosc 2009; 70: 542-545. 9) Nubiola P, Badia JM, Martinez-Rodenas F, et al: Treatment of 27 postoperative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201-995. Ann Surg 1989; 210: 56-58. 10) Evenson AR, Fischer JE: Current management of enterocutaneous fistula. J Gastrointest Surg 2006; 10: 455-464. 11) Martinez JL, Luque-de-Leon E, Mier J, et al: Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg 2008; 32: 436-443. 1) Cameron R, Binmoeller KF: Cyanoacrylate applications in the GI tract. Gastrointest Endosc 2013; 77: 846-857. 6) Rotondano G, Viola M, Orsini L, et al: Uncommon cause of early postoperative colonic fistula successfully treated with endoscopic acrylate glue injection. Gastrointest Endosc 2008; 67: 183-186. 12) Lange V, Meyer G, Wenk H, et al: Fistuloscopy-an adjuvant technique for sealing gastrointestinal fistulae. Surg Endosc 1990; 4: 212-216. 13) Katada K, Sano H, Katoh Y, et al: Ethyl 2-cyanoacrylate as an embolic agent for cranial arteriovenous malformations. An experimental study. Acta Radiol Suppl 1986; 369: 623-626. 7) Ojima T, Nakamori M, Nakamura M, et al: Successful treatment of esophageal fistulas with endoscopic injection of alpha-cyanoacrylate monomer. Endoscopy 2014; 46: E62-63. 15) Willetts IE, Dudley NE, Tam PK: Endoscopic treatment of recurrent tracheo-oesophagealfistulae: long-term results. Pediatr Surg Int 1998; 13: 256-258. 14) Billi P, Alberani A, Baroncini D, et al: Management of gastrointestinal fistulas with n-2-butyl-cyanoacrylate. Endoscopy 1998; 30: S69. 3) Yoon JH, Lee HL, Lee OY, et al: Endoscopic treatment of recurrent congenital tracheoesophageal fistula with Histoacryl glue via the esophagus. Gastrointest Endosc 2009; 69: 1394-1396. |
| References_xml | – reference: 13) Katada K, Sano H, Katoh Y, et al: Ethyl 2-cyanoacrylate as an embolic agent for cranial arteriovenous malformations. An experimental study. Acta Radiol Suppl 1986; 369: 623-626. – reference: 9) Nubiola P, Badia JM, Martinez-Rodenas F, et al: Treatment of 27 postoperative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201-995. Ann Surg 1989; 210: 56-58. – reference: 1) Cameron R, Binmoeller KF: Cyanoacrylate applications in the GI tract. Gastrointest Endosc 2013; 77: 846-857. – reference: 4) Melmed GY, Kar S, Geft I, Lo SK: A new method for endoscopic closure of gastrocolonicfistula: novel application of a cardiac septal defect closure device (with video). Gastrointest Endosc 2009; 70: 542-545. – reference: 6) Rotondano G, Viola M, Orsini L, et al: Uncommon cause of early postoperative colonic fistula successfully treated with endoscopic acrylate glue injection. Gastrointest Endosc 2008; 67: 183-186. – reference: 2) Barthelemy C, Audigier JC, Fraisse H: A non-tumoral esophago-bronchial fistula managed by isobutyl-2-cyanoacrylate. Endoscopy 1983; 15: 357-358. – reference: 7) Ojima T, Nakamori M, Nakamura M, et al: Successful treatment of esophageal fistulas with endoscopic injection of alpha-cyanoacrylate monomer. Endoscopy 2014; 46: E62-63. – reference: 10) Evenson AR, Fischer JE: Current management of enterocutaneous fistula. J Gastrointest Surg 2006; 10: 455-464. – reference: 11) Martinez JL, Luque-de-Leon E, Mier J, et al: Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg 2008; 32: 436-443. – reference: 3) Yoon JH, Lee HL, Lee OY, et al: Endoscopic treatment of recurrent congenital tracheoesophageal fistula with Histoacryl glue via the esophagus. Gastrointest Endosc 2009; 69: 1394-1396. – reference: 12) Lange V, Meyer G, Wenk H, et al: Fistuloscopy-an adjuvant technique for sealing gastrointestinal fistulae. Surg Endosc 1990; 4: 212-216. – reference: 5) Bège T, Emungania O, Vitton V, et al: An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc 2011; 73: 238-244. – reference: 15) Willetts IE, Dudley NE, Tam PK: Endoscopic treatment of recurrent tracheo-oesophagealfistulae: long-term results. Pediatr Surg Int 1998; 13: 256-258. – reference: 14) Billi P, Alberani A, Baroncini D, et al: Management of gastrointestinal fistulas with n-2-butyl-cyanoacrylate. Endoscopy 1998; 30: S69. – reference: 8) Iwata T, Chung K, Toda M, et al: Malignant esophagobronchial fistula with severe esophageal stenosis, successfully treated by transbronchial occlusion with cyanoacrylate glue. Endoscopy 2012; 44: E317-318. |
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| Snippet | 食道破裂に対する治療法に関するコンセンサスは得られていない。手術不能症例は保存的加療が行われるが，治療過程で食道難治性瘻孔となることが多い。難治性瘻孔の治療として生体接着剤を用いた瘻孔充填術の報告が散見される。私達は食道破裂後瘻孔に対するalpha-cyanoacrylate... The application of glue is an established treatment for fistulas. We consider that the alpha-cyanoacrylate monomer (α-CA) is ideal for glue embolization in the... |
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| SubjectTerms | シアノアクリレート 内視鏡治療 食道破裂 |
| Title | 食道破裂に対する内視鏡治療の可能性 |
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| ispartofPNX | 日本腹部救急医学会雑誌, 2015/01/31, Vol.35(1), pp.079-084 |
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