Successful Therapy of Esophageal Fistulas by Endoscopic Injection of Emulsified Adipose Tissue Stromal Vascular Fraction

Nachira, Dania; Trivisonno, Angelo; Costamagna, Guido; Toietta, Gabriele; Margaritora, Stefano; Pontecorvi, Valerio; Punzo, Giovanni; Porziella, Venanzio; Boškoski, Ivo

doi:10.1053/j.gastro.2020.12.063

Cited by 13 publications

(9 citation statements)

References 7 publications

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“…For patients with intractable mediastinal pleural leak, the drainage tube, as a foreign body retained in the body for a prolonged period throughout the leak, negatively affects the healing of the leak ( 8 ). Some researchers have made progress in treating intrathoracic anastomotic leak by endoscopic injection of emulsified adipose-derived stem cell (ASC) glue, but further data are needed to confirm its effect ( 4 ). Other researchers have applied SCM tamponade to occlude refractory cervical esophagogastric anastomotic leak and have achieved good results ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…tSVFem has the potential of immunosuppression, immunoregulation, angiogenesis, and regeneration, and is a promising new method for promoting healing ( 4 ). According to its mechanism, tSVFem has anti-inflammatory and tissue regeneration effects, which can safely and effectively promote tissue healing ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…Conventional thoracotomy for anastomotic leak is a high-risk surgery, requiring candidates to have better physical conditions, such as infection control measures and individuals with a higher body mass index (BMI). Some studies have shown that both sternocleidomastoid (SCM) muscle and emulsified adipose tissue stromal vascular fraction can effectively treat anastomotic mediastinal leak, but there is still a certain failure rate ( 2 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Effect of sternocleidomastoid flap repair and endoscopic injection of emulsified adipose tissue stromal vascular fraction in the treatment of refractory cervical anastomotic leak contaminating mediastinum

Liu,

Ma,

Liu

et al. 2024

J Thorac Dis

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Mediastinal infection caused by anastomotic leak is hard to cure, mainly because the poor drainage at the site of mediastinal infection leads to persistent cavity infection, which in turn becomes a refractory mediastinal abscess cavity after minimally invasive esophagectomy (MIE)-McKeown. Herein, we explored sternocleidomastoid (SCM) muscle flaps and emulsified adipose tissue stromal vascular fraction containing adipose-derived stem-cells to address this issue. We studied 10 patients with esophageal cancer who underwent MIE-McKeown + 2-field lymphadenectomy and developed anastomotic and mediastinal leak and received new technology treatment in the Affiliated Cancer Hospital of Zhengzhou University from June 2018 to March 2022. The clinical data and prognosis of the patients were collected and analyzed. A total of 5 patients received this surgery, and no other complications occurred during the perioperative period. Among the 5 patients, 1 patient was partially cured, and 4 patients were completely cured. During the follow-up 3 months postoperatively, all these 5 patients could eat regular food smoothly, and no relapse of leak and mediastinal infection occurred. The new surgical method has achieved good results in the treatment of anastomotic leak. Compared with the traditional thoracotomy, it is a less invasive and feasible surgical approach, which can be used as a supplement to the effective surgical treatment of cervical anastomotic leak contaminating the mediastinum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of sternocleidomastoid flap repair and endoscopic injection of emulsified adipose tissue stromal vascular fraction in the treatment of refractory cervical anastomotic leak contaminating mediastinum

Liu,

Ma,

Liu

et al. 2024

J Thorac Dis

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“…Fistula closure was obtained in all five cases after 7 days of injection. Long-term follow-up after a median of 8 months showed persistent defect closure [ 102 ]. These data should be confirmed in larger prospective studies.…”

Section: New Conceptsmentioning

confidence: 99%

Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review

et al. 2023

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Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.

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“…New endoscopic bariatric techniques, such as endoscopic sleeve gastroplasty (ESG) [5], have been developed that are based on the availability of new full-thickness suturing devices. The new full-thickness suturing devices, together with stents, clips, and fistula closure methods, among other tools [6][7][8][9][10], make endoscopy the first approach to managing the complications of bariatric surgery, especially because of its minimally invasive nature and repeatability.…”

Section: Introductionmentioning

confidence: 99%

Curriculum for bariatric endoscopy and endoscopic treatment of the complications of bariatric surgery: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2023

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Main recommendationsObesity is a chronic, relapsing, degenerative, multifactorial disease that is associated with many co-morbidities. The global increasing burden of obesity has led to calls for an urgent need for additional treatment options. Given the rapid expansion of bariatric endoscopy and bariatric surgery across Europe, the European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. This curriculum is set out in terms of the prerequisites prior to training, minimum number of procedures, the steps for training and quality of training, and how competence should be defined and evidenced before independent practice. 1 ESGE recommends that every endoscopist should have achieved competence in upper gastrointestinal endoscopy before commencing training in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. 2 Trainees in bariatric endoscopy and the endoscopic treatment of the complications of bariatric surgery should have basic knowledge of the definition, classification, and social impact of obesity, its pathophysiology, and its related co-morbidities. The recognition and management of gastrointestinal diseases that are more common in patients with obesity, along with participation in multidisciplinary teams where obese patients are evaluated, are mandatory. 3 ESGE recommends that competency in bariatric endoscopy and the endoscopic treatment of the complications of bariatric surgery can be learned by attending validated training courses on simulators initially, structured training courses, and then hands-on training in tertiary referral centers.

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Successful Therapy of Esophageal Fistulas by Endoscopic Injection of Emulsified Adipose Tissue Stromal Vascular Fraction

Cited by 13 publications

References 7 publications

Effect of sternocleidomastoid flap repair and endoscopic injection of emulsified adipose tissue stromal vascular fraction in the treatment of refractory cervical anastomotic leak contaminating mediastinum

Effect of sternocleidomastoid flap repair and endoscopic injection of emulsified adipose tissue stromal vascular fraction in the treatment of refractory cervical anastomotic leak contaminating mediastinum

Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review

Curriculum for bariatric endoscopy and endoscopic treatment of the complications of bariatric surgery: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

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