Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience

Mencio, Marissa; Ontiveros, Estrellita; Burdick, J. Steven; Leeds, Steven G.

doi:10.1007/s00464-018-6055-x

Cited by 48 publications

(33 citation statements)

References 28 publications

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“…Nineteen series were finally selected for the present analysis. Overall, the quality of the included studies is low – eight retrospective series , six prospective , the design was not reported in four , and there was one case report . Two of them were small comparative series , and three were multicentre studies .…”

Section: Resultsmentioning

confidence: 97%

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Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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Aim The aim of the present work was to perform an up‐to‐date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. Method An electronic search in PubMed and Google Scholar and a manual search without language restrictions were performed on 25 January 2019. Only original series reporting endoluminal negative pressure therapy in colorectal anastomotic leaks were included. The primary outcome was the success rate (complete closure of the abscess cavity). The secondary outcomes were the rates of complications and stoma closure. Results Nineteen series with a total of 295 cases were analysed. The median distance of the anastomosis from the anal verge and the size of the abscess were 5.65 cm (4.9–10) and 6.0 cm (5–8.1) respectively. In 84.5% (78%–91%) the stoma was created at the first intervention. Neoadjuvant therapy was performed in 48.6% (3%–60%). Median 7 sponges (2–34) were used with median negative pressure 150 mmHg (125–700) for a median of 31 days (14–127). The success rate was 85.4% (80%–91%) with ileostomy closure in 72.6%. Complications were observed in 19% (13%–25%): abscesses 11.5% and anastomotic stenosis 4.4%. Laparotomy was required in 15% of the complications. The stoma was the only significant predictor for the success of the therapy (0.007, SE 0.004, P = 0.040). Conclusions The initial experience looks promising with an 85% success rate, which precludes risky re‐resections with redo anastomosis or Hartmann's procedure. Despite the good initial results, definitive conclusions cannot be drawn because of the small sample size and the lack of high‐quality comparative studies.

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Section: Resultsmentioning

confidence: 97%

“…A total of 114 publications were found. Thirty of them, published between 2006 and 2018, were considered relevant . Four were excluded because they reported overlapping cases and only the most recent series were included .…”

Section: Resultsmentioning

confidence: 99%

Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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“…Recently, reports of endoluminal negative pressure treatment have frequently used. It is the method that can treat the AL with minimal invasion by using sponge trans-anal in abscess and apply continuous negative pres-sure to close the abscess cavity [4][5][6][7][8] . However, according to a review by G.I.Popivanov et al, there were 84.5% patients who needed to create stoma, and 72.6% patients underwent stoma closure.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy and outcome of anastomotic leakage after left-sided colorectal cancer surgery –Non-surgical V.S. Surgical treatment–

Imanishi

Miyauchi

Maruyama

et al. 2019

Ann. Cancer Res. Therap.

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Anastomotic leakage (AL) after left-sided colorectal cancer surgery is one of the most serious complication. Once anastomotic leakage occur, we have to select the treatment, non-surgical or surgical. The aim of this study is to evaluate the outcome of the treatments for AL after left-sided colorectal surgery in our institution. Fifty-five patients who had AL after left-sided colorectal surgery were included in this study. Thirty nine were treated for non-surgical treatment (non-surgical group). In eight patients, we had to change the strategy from non-surgical to surgical during non-surgical treatment (convert group). Eight patients were treated for surgical treatment at first due to generalized peritonitis (surgical group). There were not significant differences in patient's background and blood examination between these groups. The patients who had three symptoms (the change of drain contents, fever higher than 38℃ and abdominal pain) in convert group were significantly more frequent than those of non-surgical group (50%:7.7% P = 0.01). The rate of diverting stoma in non-surgical group were significantly more frequent than those of convert and surgical groups (25.6%:6.2% P < 0.001). In all of 55 patients, the rate of permanent stoma was 9% and mortality was 0%. In selected patients without generalized peritonitis, AL after left-sided colorectal cancer can be controlled by non-surgical treatment. Furthermore it may decrease the rate of permanent stoma. Moreover, we should select surgical treatment at first step for the patients who had three clinical symptoms even in the absence of findings of generalized peritonitis.

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“…To date, several retrospective studies on ENPT have reported on more than 300 patients with esophageal defects of varying etiology [7–18, 20–23, 25]. Healing rates range from 60 to 100% (Table 1).…”

Section: Enpt In the Esophagusmentioning

confidence: 99%

Endoscopic negative pressure therapy of the upper gastrointestinal tract

Loske

2018

Chirurg

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Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.

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Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience

Abstract: Our experience demonstrates that EVAC therapy is feasible and effective for the management of gastrointestinal perforations/leaks throughout the GI tract and can be considered as a safe alternative to surgical intervention in select cases.

Cited by 48 publications

References 28 publications

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Treatment strategy and outcome of anastomotic leakage after left-sided colorectal cancer surgery –Non-surgical V.S. Surgical treatment–

Endoscopic negative pressure therapy of the upper gastrointestinal tract

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