Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?

Hirsch, Bruno Salomão; Neto, Heli Clóvis de Medeiros; Oliveira, Victor De; Bestetti, Alexandre Moraes; Moura, Bruna Furia Buzetti Hourneaux de; Khashab, Mouen A.; Moura, Eduardo Guimarães Hourneaux de

doi:10.1007/s11938-023-00421-5

Cited by 2 publications

(2 citation statements)

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“…Since the first cases reports, EVT has been used in the management of transmural gastrointestinal (GI) defects (TGIDs) in several organs ( 2 ) such as esophagus ( 3 , 4 ), stomach (mainly for post-bariatric surgical leaks) ( 5 - 7 ), small bowel (mostly duodenum) ( 8 ), colorectal defects ( 9 ), and also in the liver ( 10 ) with high efficacy and satisfactory safety profile ( 2 , 4 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic vacuum therapy: pitfalls, tips and tricks, insights, and perspectives

de Moura,

Hirsch,

Ribas

et al. 2024

Transl Gastroenterol Hepatol

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This article provides a comprehensive review of the use of endoscopic vacuum therapy (EVT) in the management of transmural gastrointestinal (GI) defects (TGIDs) and its future perspectives, such as pre-emptive EVT and novel indications, including GI bleeding and large gastroduodenal ulcers management. This review is based on the available literature data and personal experience to demystify the mentioned limitations of EVT as technical difficulties related to the procedure, possible patients’ complaints, and institutions’ concerns, by sharing several tips and tricks to overcome EVT-related challenges that may discourage endoscopists from using this live-saving technique, and consequently, restricting patients to receive this therapy, which may lead to undesired outcomes. Several factors, such as placement techniques, EVT type selection, management during its use, EVT system exchanges, device removal, type of anesthesia, and how to avoid EVT-related adverse events are described in detail. Additionally, this review discusses good ways to promote effective communication with patients and relatives, surgeons, and multidisciplinary team. EVT possesses a unique mechanism of action including macro/micro deformation, changes in perfusion (stimulating angioneogenesis), exudate control, and bacterial clearance, promoting healing. EVT has an adequate safety profile and higher clinical success rate compared to any other endoscopic therapy for TGID. Additionally, pre-emptive EVT and its novel indications are promising due to its satisfactory effectiveness in initial studies. Therefore, detailing some practical solutions obtained by years of experience may collaborate to widespread EVT adoption, providing less-invasive treatment for several critical conditions to more patients worldwide.

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Section: Introductionmentioning

confidence: 99%

“…EVT allows continuous drainage of GI fluids, reducing edema, increasing local perfusion, and thus promoting healing through a unique mechanism of action, including macro and micro deformation, changes in perfusion (stimulating angioneogenesis), exudate control, and bacterial clearance ( 4 , 12 ).…”

Section: Introductionmentioning

confidence: 99%