Tiivistelmä

Maha-suolikanavan yläosan ahtaumia, puhkeamia ja leikkaussauman pettämisiä voidaan hoitaa endoskooppisesti itsestään laajenevilla metalliverkkoproteeseilla.

Puhkeamien tai leikkaussauman pettämisten uudempana hoitovaihtoehtona on endoluminaalinen alipaineimuhoitojärjestelmä.

Kaikutähystystä käytetään sekä diagnostiikkaan että toimenpiteiden tekemiseen.

Limakalvoon rajoittuvat muutokset voidaan valikoidusti poistaa endoskopiassa.

Toimenpiteiden haasteellisuus ja komplikaatioriskit puoltavat vaativien toimenpiteiden keskittämistä.

Abstract

Oesophageal obstructions, perforations and leaks have been successfully treated with self-expanding metal stents (SEMS). In gastric outlet obstruction, stenting also provides efficient and fast palliation of symptoms, with low morbidity and short hospital stay. Especially for terminally ill patients, stenting is the therapy of choice. Pancreatic cancer and gastric cancer are the most common reasons for gastric outlet obstruction.

Endoscopic vacuum therapy (EVT) has become a useful option to treat perforations and leaks in the upper gastrointestinal tract. A sponge is introduced transorally into the leakage cavity or oesophageal lumen and is connected via a drainage tube to a continuous negative pressure up to 125 mmHg. The sponge is replaced every 3–5 days. However, more comparative studies are needed to compare EVT and SEMS therapy. EVT has been used longer to treat low rectal anastomotic leaks.

Use of endoscopic ultrasound has been extended from diagnostic use to EUS-guided therapeutic endoscopies.

Many superficial mucosal dysplastic or neoplastic lesions can be treated by mucosal resection in the upper gastrointestinal tract, too. Endoscopic mucosal resection (EMR) is used for piecemeal resection of mucosal lesions, for example a nodular dysplastic lesion in Barrett’s oesophagus. Endoscopic submucosal dissection (ESD) has been developed for dissection of larger mucosal lesions to achieve en bloc resection and to obtain a single larger specimen for histologic examination. ESD is technically quite demanding and requires a longer operation time compared to EMR. For treatment of Barrett’s oesophagus (BO) with non-granular dysplasia, radiofrequency ablation is a safe and effective mucosal eradication method.