Background

Anastomotic complications such as leaks, bleeding, and stricture remain the most serious complications of surgery for gastric cancer. No perfect method exists for an accurate and reliable prevention of these complications. This study investigated the safety and efficacy of post-anastomotic intraoperative endoscopy (PAIOE) for avoidance of early anastomotic complications during gastrectomy in gastric cancer.

Methods

This retrospective case–control study enrolled patients from a tertiary care, academic medical center. Routine PAIOE was performed on 319 patients undergoing gastrectomy for gastric cancer between 2015 and 2016. As controls, without PAIOE 270 patients from 2013 to 2014 were used for comparison. Early anastomotic complications and outcomes after PAIOE were determined.

Results

Although there were no differences between the PAIOE and non-PAIOE group in terms of overall complication rates (20.1% vs 26.7%; P > 0.05), there were fewer complications related to anastomosis (3.4% vs 8.9%; P < 0.01) in the PAIOE group. The PAIOE group had rates of 2.5% for anastomotic leakage, 0.9% for intra-luminal bleeding, and 0% for anastomotic stenosis, while the non-PAIOE group exhibited rates of 5.6%, 2.6%, and 0.7%, respectively. Thirty-one abnormalities were detected in 26 PAIOE patients (9.71%) (20 venous bleeding, 7 mucosal tearing, 2 air leaks, 1 arterial bleeding, and 1 anastomotic stricture). All abnormalities were corrected by proper interventions (13 reinforced additional suture, 13 endoscopic hemostasis, and 2 re-anastomosis). There were no morbidities associated with PAIOE.

Conclusions

PAIOE appears to be a safe and reliable procedure to evaluate the stability of gastrointestinal anastomosis for gastric cancer patients. Further data collection and a well-designed prospective study are needed to confirm the validity of PAIOE.

中文翻译：

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吻合术后术中内镜避免胃癌胃切除术中早期吻合并发症的安全性和有效性

背景

吻合口并发症，如渗漏，出血和狭窄仍是胃癌手术中最严重的并发症。没有准确，可靠地预防这些并发症的完美方法。这项研究调查了胃癌手术后术中内镜检查（PAIOE）避免早期吻合并发症的安全性和有效性。

方法

这种回顾性病例对照研究中登记的患者从一个牛逼ertiary保健，学术医疗中心。在2015年至2016年之间，对319例胃癌胃切除术患者进行了常规PAIOE。作为对照组，在没有PAIOE的情况下，将2013年至2014年的270例患者作为对照。确定PAIOE后的早期吻合并发症和预后。

结果

甲lthough有在总的并发症率方面的PAIOE和非PAIOE组之间无显着差异（20.1％对26.7％; P  > 0.05），有与吻合术（3.4％对8.9％更少的并发症; P <0.01）。PAIOE组的吻合口漏率为2.5％，腔内出血为0.9％，吻合口狭窄为0％，而非PAIOE组的吻合口漏率分别为5.6％，2.6％和0.7％。在26例PAIOE患者中检测到31例异常（9.71％）（20例静脉出血，7例粘膜撕裂，2例漏气，1例动脉出血和1例吻合口狭窄）。通过适当的干预措施纠正了所有异常（13根额外的缝合线，13例内镜止血和2例再吻合）。没有与PAIOE相关的疾病。

结论

PAIOE似乎是评估胃癌患者胃肠道吻合术稳定性的安全可靠的方法。需要进一步的数据收集和精心设计的前瞻性研究来确认PAIOE的有效性。