Abstract:BackgroundLeaks from the upper gastrointestinal tract often pose a management challenge, particularly when surgical treatment has failed or is impossible. Vacuum therapy has revolutionised the treatment of wounds, and its role in enabling and accelerating healing is now explored in oesophagogastric surgery.MethodsA piece of open cell foam is sutured around the distal end of a nasogastric tube using a silk suture. Under general anaesthetic, the foam covered tip is placed endoscopically through the perforation a… Show more
“…We do not rinse the drain prior to removal. There have been rare reports of bleeding complications due to erosions when using OPDs for extraluminal intracavitary ENPT in esophageal defects [6, 9]. Fig.…”
Section: Open-pore Polyurethane Foams Erosive Suction Patterns and mentioning
Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.
“…We do not rinse the drain prior to removal. There have been rare reports of bleeding complications due to erosions when using OPDs for extraluminal intracavitary ENPT in esophageal defects [6, 9]. Fig.…”
Section: Open-pore Polyurethane Foams Erosive Suction Patterns and mentioning
Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.
“…So far, only a few reports have described use of ENPT in cases of duodenal leakages 9 10 11 12 13 14 15 16 17 18 . In this retrospective study, we demonstrate use of ENPT in a population of 11 patients.…”
IntroductionIntestinal leakage is often associated with critical illness due to septic condition. The therapeutic aim is to control the septic conditions, focusing on closing the intestinal defect and establishing sufficient drainage [1]. Endoscopic procedures are of increasing importance in management of intestinal defects [2 -4].Initially, negative pressure wound therapy was developed to treat superficial infected wounds. Subsequently intracorporal endoscopic negative pressure therapy (ENPT) (also known as endoscopic vacuum therapy, E-vac therapy, and endo-vac ther-apy) was also found to be effective in healing intracorporal wounds. ENPT was initially used to treat anastomotic insufficiencies in the rectum [5], and was subsequently adapted to treat esophageal leakages [6]. To date, more than 200 patients with transmural defects of the esophagus (anastomotic leaks and perforations) have been treated with a healing rate of 90 % [7,8].So far, only a few reports have described use of ENPT in cases of duodenal leakages [9 -18]. In this retrospective study, we demonstrate use of ENPT in a population of 11 patients. Pertinent information on six patients already has been published in a small primary case series or first case reports [9 -13].
ABSTR AC TBackground and study aims Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages.Patients and methods The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of -125 mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days.Results Eleven patients were treated with duodenal leaks.Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth -1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 -24 days). Complete healing of defects was achieved in all patients.Conclusion ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects.
“…These considered small patient cohorts with only 1-39 patients (12,39,47). The reported success rates of EVT for anastomotic leakages are high (66-100%) (12,13,36,39,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Accordingly, adverse event rates are low (0-14.8%) (12,39,47,51,52).…”
BackgroundAnastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening adverse events. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection. MethodsFrom March 2014 to September 2019 259 consecutive patients underwent elective transthoracic esophageal resection. 72 patients (27,8 %) suffered from AL. The overall collective in-hospital mortality rate was 3.9% (n=10). Data from those who underwent treatment with EVT were included. ResultsFifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n=49) by EVT only. The EVT-associated adverse event rate was 5.4% (n=3): bleeding occurred in one patient, while minor sedation-related adverse events were observed in two patients. The median number of EVT procedures per patient was 3. The procedures were performed at intervals of 3-5 days, with a 14-day median duration of therapy. The mortality rate of patients with AL was 7.2% (n=4). Despite successfully terminated EVT, three patients died because of multiple organ failure, acute respiratory distress syndrome, and urosepsis (5.4%). One patient (1.8%) died during EVT due to cardiac arrest. ConclusionsEVT is a safe and effective approach for intrathoracic anastomotic leakages following abdomino-thoracic esophageal resections. It offers a high leakage-closure rate and the potential to lower leakage-related mortalities.
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