Improved colorectal anastomotic leakage healing by transanal rinsing treatment after endoscopic vacuum therapy using a novel patient-applied rinsing catheter

Kantowski, Marcus; Kunze, Andreas; Bellon, Eugen; Rösch, Thomas; Settmacher, Utz; Tachezy, Michael

doi:10.1007/s00384-019-03456-2

Cited by 12 publications

(20 citation statements)

References 16 publications

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“…6 ) . Anastomotic stenosis accounted for the most frequent complication after EVT in n = 24 (0 up to 18.2% [ 18 ]) reported cases, followed by fistulas n = 17 (0 up to 28.6% [ 24 ]), abscess formation and chronic sinus (presacral abscess persisting > 12 months) in n = 15 (0 up to 21.7% [ 11 ]), and bleeding complications n = 9 (0 up to 9.7% [ 25 ]). There was no reported mortality related to EVT [ 7 – 29 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…As shown in the study by Weidenhagen et al all stenoses could be successfully treated with an average of six balloon dilations, and an overall ostomy closure rate of 88% was achieved [ 2 ]. Other reported complications are fistulas in n = 17 [ 13 , 16 , 24 , 25 , 27 ], abscesses in n = 15 [ 9 , 11 , 16 , 22 , 23 ] and bleeding in n = 9 cases [ 7 , 9 , 25 , 27 ] in total.…”

Section: Discussionmentioning

confidence: 99%

“…3 Forest plot for success rate of EVT across the studies. Success rates are shown with 95% CI persisting > 12 months) in n = 15 (0 up to 21.7% [11]), and bleeding complications n = 9 (0 up to 9.7% [25]). There was no reported mortality related to EVT 37].…”

Section: Evt-associated Morbiditymentioning

confidence: 95%

“…The studies were from the following countries of origin: Italy (n = 6), Germany (n = 5), Netherlands (n = 5), Denmark (n = 2), Spain (n = 1), Sweden (n = 1), Austria (n = 1), Turkey (n = 1), USA (n = 1), France (n = 1). These publications comprise 18 retrospective studies [3,8,9,[12][13][14][15][16][17][18][23][24][25][26][27][28][29] and 6 prospective studies [10,11,[19][20][21][22]. Due to the lack of data from RCTs, a few prospective and mostly retrospective case series on EVT treatment of colorectal defects were included in this systematic review.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Endoscopic vacuum therapy for the treatment of colorectal leaks — a systematic review and meta-analysis

Kühn

Schardey

Wirth

et al. 2021

Int J Colorectal Dis

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Background During the last two decades, vacuum-assisted wound therapy has been successfully transferred to an endoscopic treatment approach of various upper and lower gastrointestinal leaks called endoscopic vacuum therapy (EVT). As mostly small case series are published in this field, the aim of our systematic review and meta-analysis was to evaluate the efficacy and safety of EVT in the treatment of colorectal leaks. Methods A systematic search of MEDLINE/PubMed and Cochrane databases was performed using search terms related to EVT and colorectal defects (anastomotic leakage, rectal stump insufficiency) according to the PRISMA guidelines. Randomized controlled trials (RCTs), observational studies, and case series published by December 2020 were eligible for inclusion. A meta-analysis was conducted on the success of EVT, stoma reversal rate after EVT as well as procedure-related complications. Statistical interferences were based on pooled estimates from random effects models using DerSimonian-Laird estimator. Results Only data from observational studies and case series were available. Twenty-four studies reporting on 690 patients with colorectal defects undergoing EVT were included. The mean rate of success was 81.4% (95% CI: 74.0%–87.1%). The proportion of diverted patients was 76.4% (95% CI: 64.9%–85.0%). The mean rate of ostomy reversal across the studies was 66.7% (95% CI: 58.0%–74.4%). Sixty-four patients were reported with EVT-associated complications, the weighted mean complication rate across the studies was 12.1% (95% CI: 9.7%–15.2%). Conclusions Current medical evidence on EVT in patients with colorectal leaks lacks high quality data from RCTs. Based on the data available, EVT can be seen as a feasible treatment option with manageable risks for selected patients with colorectal leaks.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Evt-associated Morbiditymentioning

confidence: 95%

Section: Study Characteristicsmentioning

confidence: 99%

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Endoscopic vacuum therapy for the treatment of colorectal leaks — a systematic review and meta-analysis

Kühn

Schardey

Wirth

et al. 2021

Int J Colorectal Dis

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“…Continuous aspiration with 125 mmHg negative pressure was started (▶ Video 1). The pump was disconnected daily so tubes could be used to irrigate the cavity [1][2][3]. After 10 days, a new rectoscopy showed significant reduction of leakage and the pelvic cavity, with granulation tissue formation.…”

mentioning

confidence: 99%

Endoscopic treatment of rectovesical fistula after colorectal anastomosis: tube-in-tube endoscopic vacuum therapy method

et al. 2021

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Challenges in the interdisciplinary treatment of leakages after left-sided colorectal surgery: endoscopic negative pressure therapy, open-pore film drainage therapy and beyond

Scognamiglio

Seeger

Reeh

et al. 2023

Int J Colorectal Dis

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Purpose The treatment of anastomotic leakage after left colorectal surgery remains challenging. Since its introduction, endoscopic negative pressure therapy (ENPT) has proven to be advantageous, reducing the necessity of surgical revision. The aim of our study is to present our experience with endoscopic treatment of colorectal leakages and to identify potential factors influencing treatment outcome. Methods Patients who underwent endoscopic treatment of colorectal leakage were retrospectively analyzed. Primary endpoint was the healing rate and success of endoscopic therapy. Results We identified 59 patients treated with ENPT between January 2009 and December 2019. The overall closure rate was 83%, whereas only 60% of the patients were successfully treated with ENPT and 23% needed further surgery. The time between diagnosis of leakage and uptake of endoscopic treatment did not influence the closure rate, but patients with chronic fistula (> 4 weeks) showed a significantly higher reoperation rate than those with an acute fistula (94% vs 6%, p = 0.01). Conclusion ENPT is a successful treatment option for colorectal leakages, which appears to be more favorable when started early. Further studies are still needed to better describe its healing potential, but it deserves an integral role in the interdisciplinary treatment of anastomotic leakages.

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Improved colorectal anastomotic leakage healing by transanal rinsing treatment after endoscopic vacuum therapy using a novel patient-applied rinsing catheter

Cited by 12 publications

References 16 publications

Endoscopic vacuum therapy for the treatment of colorectal leaks — a systematic review and meta-analysis

Endoscopic vacuum therapy for the treatment of colorectal leaks — a systematic review and meta-analysis

Endoscopic treatment of rectovesical fistula after colorectal anastomosis: tube-in-tube endoscopic vacuum therapy method

Challenges in the interdisciplinary treatment of leakages after left-sided colorectal surgery: endoscopic negative pressure therapy, open-pore film drainage therapy and beyond

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