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Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen 1/2020

07.01.2020 | Originalien

Therapie der Ösophagusleckagen

verfasst von: OÄ Dr. Jutta Weber-Eibel

Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen | Ausgabe 1/2020

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Zusammenfassung

Ösophagusleckagen stellen eine kritische und lebensbedrohliche Situation mit hoher Morbidität und Mortalität dar. Neben der Beherrschung möglicher septischer Komplikationen muss rasch ein der individuellen Situation angepasster Verschluss oder eine Deckung dieser Vollwandrupturen erfolgen. War früher die chirurgische Sanierung Standard, hat heute die endoskopische Therapie durch Einsatz spezieller Materialien und effektiver Applikationstechniken ihren Stellenwert als Erstlinientherapie erlangt. Es stehen neben diversen Modellen von Metall- und Plastikstents (SEMS, SEPS) mit oder ohne Beschichtung mehrere Clipvarianten zur Verfügung, die sowohl als Through-the-scope(TTS)- als auch als Over-the-scope(OTS)-Clip eingesetzt werden können. Therapieversuche mittels Gewebekleber sind in den Hintergrund getreten. Da insbesondere große infizierte Nekrosehöhlen ein therapeutisches Problem darstellen, hat man sich das Konzept der Vakuumschwammtherapie zunutze gemacht, um durch einen kontinuierlichen Sog und die Aufnahme von Sekret die Heilung der Wundhöhle zu fördern. Eine weitere Ergänzung stellen Nahtsysteme dar, die aber für den großzügigen Einsatz noch weiter evaluiert werden müssen. Die Regenerationsmedizin des Ösophagus ist zwar eine Zukunftsvision, doch hat diese bereits mit der Herstellung von Stents begonnen, die zur Förderung der Gewebeproliferation mit einer Extrazellularmatrix ummantelt sind. Nachwuchsendoskopiker müssen an diese Möglichkeiten des Komplikationsmanagements in strukturierten Ausbildungsprogrammen herangeführt werden.
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Metadaten
Titel
Therapie der Ösophagusleckagen
verfasst von
OÄ Dr. Jutta Weber-Eibel
Publikationsdatum
07.01.2020
Verlag
Springer Vienna
Erschienen in
Journal für Gastroenterologische und Hepatologische Erkrankungen / Ausgabe 1/2020
Print ISSN: 1728-6263
Elektronische ISSN: 1728-6271
DOI
https://doi.org/10.1007/s41971-019-00066-1

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