Endoscopic Treatment Options for Gastrointestinal Leaks

Abstract

<b><i>Background:</i></b> Spontaneous or postoperative gastrointestinal defects are still life-threatening complications with elevated morbidity and mortality. Recently, endoscopic treatment options – up and foremost endoscopic vacuum therapy (EVT) – have become increasingly popular and have shown promising results in these patients. <b><i>Methods:</i></b> We performed an electronic systematic search of the MEDLINE databases (PubMed, EMBASE, and Cochrane) and searched for studies evaluating endoscopic options for the treatment of esophageal and colorectal leakages and/or perforations until March 2022. <b><i>Results:</i></b> The closure rate of both esophageal and colorectal defects by EVT is high and even exceeds the results of surgical revision in parts. Out of all endoscopic treatment options, EVT shows most evidence and appears to have the highest therapeutic success rates. Furthermore, EVT for both indications had a low rate of serious complications without relevant in-hospital mortality. In selected patients, EVT can be applied without fecal diversion and transferred to an outpatient setting. <b><i>Conclusion:</i></b> Despite multiple endoscopic treatment options, EVT is increasingly becoming the new gold standard in endoscopic treatment of extraperitoneal defects of the upper and lower GI tract with localized peritonitis or mediastinitis and without close proximity to major blood vessels. However, further prospective, comparative studies are needed to strengthen the current evidence.

Complicações operatórias após gastrectomias: uma revisão da literatura

“…Em caso de falha no manejo conservador, piora clínica com instabilidade hemodinâmica ou suspeita de contaminação abdominal difusa o paciente deverá ser encaminhado com urgência ao centro cirúrgico para exploração, drenagem da cavidade e revisão anastomótica para prevenir ou controlar a sepse abdominal (ASHLEY, 2022). Outra opção de tratamento é a terapia endoscópica à vácuo cujas evidências foram obtidas em sua maioria no tratamento de vazamento colorretais e esofágicos, no entanto, já existem estudos comprovando sua eficácia nas fístulas pós cirurgias bariátricas (DREFS, 2022).…”

The Role of Open-Pore Film Drainage Systems in Endoscopic Vacuum Therapy: Current Status and Review of the Literature

“…The sponge has to be changed regularly, usually 2-3 times per week, until the defect is completely closed or the remaining cavity is small, covered with healthy granular tissue, and has adequate drainage to the lumen [11][12][13][14][15]. EVT has shown very good results when used for the treatment of a wide range of defects in the entire gastrointestinal tract, with success rates sometimes exceeding those of surgical treatment and with considerably less morbidity and mortality, leading some authors to describe it as the "new gold standard" in the treatment of those patients [16].…”

Postoperative Management in Visceral Medicine

“…Drefs et al [3] report on different endoscopic treatment options for postoperative gastrointestinal leaks. As reported here, endoscopic vacuum therapy (EVT) has become the mainstay of therapy for upper as well as lower GI defects.…”