Esophageal Endoscopic Vacuum Therapy with Enteral Feeding Using a Sengstaken-Blakemore Tube

Abstract

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.

Tips and tricks for endoscopic negative pressure therapy

“…The therapeutic closure of the esophagus during intraluminal ENPT complicates intestinal feeding, but integrating a feeding tube into the foam can circumvent this problem [ 10 , 11 ] and also allows for enteral feeding. If the feeding tube is to be fixed in the drainage device, we use a triple-lumen tube (Freka®Trelumina, CH/Fr 16/9, 150 cm, Fresenius Kabi AG, Germany), wrapping polyurethane foam (Suprasorb® CNP Foam, Lohmann & Rauscher GmbH & Co. KG, Neuwied, Germany) around the gastric drain opening.…”

Endoscopic negative pressure therapy of the upper gastrointestinal tract

“…This considerably simplifies endoscopic placement in the presence of an enterocutaneous fistula. To allow for intestinal feeding during intraluminal ENPT, double-lumen OPDs have been developed with an additional jejunal feeding tube [ 34 , 35 ].…”