Current endoscopic closure techniques for the management of gastrointestinal perforations

Staudenmann, Dominic; Choi, Kevin Kyung Ho; Kaffes, Arthur J.; Saxena, Payal

doi:10.1177/26317745221076705

Cited by 9 publications

(6 citation statements)

References 80 publications

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“…Statistical studies have demonstrated that different surgical approaches for perforated duodenal ulcers have significant differences regarding recovery, complications, and mortality rates [13][14][15][16]. Upon comparison between conventional approaches (open abdominal) versus minimally invasive (laparoscopic) and between the varying procedures (omental patch, suturing, and E-VAC), our case report demonstrates that the E-VAC system is the option with the best prognosis and lowest mortality rate [17][18][19][20][21][22][23][24][25][26][27]. Without the use of the E-VAC system, this patient with an ASA score of IV did not have a favorable prognosis, having a high risk of postoperative mortality [3,[16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 78%

“…Upon comparison between conventional approaches (open abdominal) versus minimally invasive (laparoscopic) and between the varying procedures (omental patch, suturing, and E-VAC), our case report demonstrates that the E-VAC system is the option with the best prognosis and lowest mortality rate [17][18][19][20][21][22][23][24][25][26][27]. Without the use of the E-VAC system, this patient with an ASA score of IV did not have a favorable prognosis, having a high risk of postoperative mortality [3,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Not only was the patient able to recover, but the patient was able to do so without any complications and with rapid recovery.…”

Section: Discussionmentioning

confidence: 95%

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Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Ciuntu,

Tanevski,

Buescu

et al. 2024

JCM

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This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient’s chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient’s healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 95%

Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Ciuntu,

Tanevski,

Buescu

et al. 2024

JCM

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“…The estimated annual rate of perforations has increased owing to the popularity and expansion of endoscopy 1 . GIT perforation is a rare and unexpected life-threatening complication associated with a high mortality rate (6–33%) 2 . Furthermore, perforations in the stomach predominantly arise from the worsening of preexisting conditions (peptic ulcers, obstructions, and malignancies), anastomotic leakage after gastrectomy, and iatrogenic causes, including endoscopy-related procedures [endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), polypectomy], and foreign bodies.…”

Section: Introductionmentioning

confidence: 99%

Application of natural orifice transluminal endoscopic surgery with ENDOCRAB system for stomach perforation model: ex vivo porcine study

Jeon,

Hwang,

Lee

et al. 2024

Sci Rep

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Iatrogenic stomach perforation is a detrimental, irreversible, and fatal condition. Traditional surgery and endoscopic suturing clips and devices have been introduced to seal holes and prevent sepsis and disease progression. However, the development of endoscopic devices for perforations remains challenging, with no standard device available. This study investigates the superficial layer approximation strengths of the newly designed ENDOCRAB system for gastric wall defects. Thirty porcine stomachs were prepared ex vivo for the perforation model and distributed equally into three groups: ENDOCRAB system, Through-the-Scope Clip (TTSC), and hand suturing (HS). Both ENDOCRAB and TTSC achieved mucosal–submucosal layer apposition, whereas HS allowed a full-thickness layer. Their air leakage pressure and procedural duration were measured. The analysis of air-leakage pressure demonstrated comparable suture strength between ENDOCRAB (118.5 ± 41.7 mmHg) and HS (127.4 ± 30.2 mmHg, P = 0.812), but inferior strength with TTSC (73.6 ± 21.6 mmHg, P = 0.012). HS achieved the shortest procedural duration, whereas ENDOCRAB and TTSC showed no significant differences. The ENDOCRAB system showed significantly greater strength than the TTSC, was comparable to HS in strength, and required a procedural duration similar to that of the TTSC. Furthermore, long-term in vivo experiments and histological evaluations are essential.

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“…Sutures and staples are considered the “gold standard” for open surgery wound closure [ 8 ]. To better adapt to minimally invasive techniques, laparoscopic or endoscopic closures of GI wounds utilize metal clips, stents, or suturing devices for different sizes and locations of GI defects [ 9 ]. Despite the excitement surrounding the early evidence concerning minimally invasive closure techniques, there are many inherent disadvantages associated with suture-based tissue sealing that include: (1) secondary damage to tissue due to needle piercing; (2) complicated, time-consuming technical processes that require high surgical skills; (3) insufficient containment of fluid leaks; and (4) infection, inflammation, and delayed healing at the site [ 6 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…To better adapt to minimally invasive techniques, laparoscopic or endoscopic closures of GI wounds utilize metal clips, stents, or suturing devices for different sizes and locations of GI defects [ 9 ]. Despite the excitement surrounding the early evidence concerning minimally invasive closure techniques, there are many inherent disadvantages associated with suture-based tissue sealing that include: (1) secondary damage to tissue due to needle piercing; (2) complicated, time-consuming technical processes that require high surgical skills; (3) insufficient containment of fluid leaks; and (4) infection, inflammation, and delayed healing at the site [ 6 , 8 , 9 , 10 , 11 ]. Therefore, there is a substantial interest and need for the development of atraumatic, minimally invasive, and easy-to-apply GI wound closure technologies to provide fluid-tight sealing and promote wound healing for different types of GI defects.…”

Section: Introductionmentioning

confidence: 99%

Advances in Hydrogel Adhesives for Gastrointestinal Wound Closure and Repair

Grinstaff

2023

Gels

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Millions of individuals undergo gastrointestinal (GI) tract surgeries each year with common postoperative complications including bleeding, perforation, anastomotic leakage, and infection. Today, techniques such as suturing and stapling seal internal wounds, and electrocoagulation stops bleeding. These methods induce secondary damage to the tissue and can be technically difficult to perform depending on the wound site location. To overcome these challenges and to further advance wound closure, hydrogel adhesives are being investigated to specifically target GI tract wounds because of their atraumatic nature, fluid-tight sealing capability, favorable wound healing properties, and facile application. However, challenges remain that limit their use, such as weak underwater adhesive strength, slow gelation, and/or acidic degradation. In this review, we summarize recent advances in hydrogel adhesives to treat various GI tract wounds, with a focus on novel material designs and compositions to combat the environment-specific challenges of GI injury. We conclude with a discussion of potential opportunities from both research and clinical perspectives.

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Current endoscopic closure techniques for the management of gastrointestinal perforations

Cited by 9 publications

References 80 publications

Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Application of natural orifice transluminal endoscopic surgery with ENDOCRAB system for stomach perforation model: ex vivo porcine study

Advances in Hydrogel Adhesives for Gastrointestinal Wound Closure and Repair

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