- Auteur(s) : Pierre Eisendrath, Jacques Devière
, Service de gastroentérologie, hôpital Erasme, 808, route de Lennik, 1070 Bruxelles, Belgique
- Mots-clés : esophageal stenosis surgery, esophageal perforation surgery, anastomosis, surgical-adverse effect, endoscopic therapy, stent
- Page(s) : 85-92
- DOI : 10.1684/hpg.2009.0286
- Année de parution : 2009
Anastomotic stenosis and fistulas are the two main complications of oesogastric surgery that can be managed endoscopically, besides anastomotic bleeding. Balloon dilatation is a safe and efficient technique that is now acknowledged as one of the first therapeutic options for stenosis. With the availability of plastic stents, the technique can now be used for benign strictures, in particular those refractory to dilatation. Other solutions, such as steroid injection and incision of strictures, are only marginal techniques. Endoscopic management of anastomotic fistulas and leaks also relies on self-expanding stents. For openings wider than 1 cm and acute dehiscence, they are a better option than other available techniques such as endoscopic clipping. Besides fistula closing, management of these complications must include an efficient drainage of perianastomotic collections through either percutaneous or endoscopic techniques. Endoscopic management of these complications is in any case less invasive than a new surgical intervention. However, the success rate is dependent on endoscopic expertise and good knowledge of the underlying surgical situation obtained through interdisciplinary communication.