Abstract
Background
Perforations and anastomotic leakages of the upper gastrointestinal (GI) tract cause a high morbidity and mortality rate. Only limited data exist for endoscopic vacuum therapy (EVT) in the upper GI tract.
Methods
Fifty-two patients (37 men and 15 women, ages 41–94 years) were treated (12/2011–12/2015) with EVT for anastomotic insufficiency secondary to esophagectomy or gastrectomy (n = 39), iatrogenic esophageal perforation (n = 9) and Boerhaave syndrome (n = 4). After diagnosis, polyurethane sponges were endoscopically positioned with a total of 390 interventions and continuous negative pressure of 125 mm of mercury (mmHg) was applied to the EVT-system. Sponges were changed endoscopically twice per week. Clinical and therapy-related data and mortality were analyzed.
Results
After 1–25 changes of the sponge at intervals of 3–5 days with a mean of 6 sponge changes and a mean duration of therapy of 22 days, the defects were healed in 94.2 % of all patients without revision surgery. In three patients (6 %), EVT failed. Two of these patients died due to hemorrhage related to EVT. Four postinterventional strictures were observed during the follow-up of up to 4 years.
Conclusion
Esophageal wall defects of different etiology in the upper gastrointestinal tract can be treated successfully with EVT, considering that indication for EVT should be weighed carefully. EVT can be regarded as a novel life-saving therapeutic tool.
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Abbreviations
- GI:
-
Gastrointestinal
- EVT:
-
Endoscopic vacuum therapy
- SEMS:
-
Self-expanding metal stent
- SEPS:
-
Self-expanding plastic stent
- CT:
-
Computed tomography
- OTSC:
-
Over-the-scope clip
- WBC:
-
White blood cell count
- CRP:
-
c-reactive protein
- PVC:
-
Polyvinyl chloride
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M.G. Laukoetter is a member of the expert panel of negative pressure wound therapy of the Paul Hartmann (AG) holding company. He received fees for invited speeches on endoscopic vacuum therapy. Drs. R. Mennigen, P.A. Neumann, S. Dhayat, G. Horst, D. Palmes, N. Senninger and T. Vowinkel have no conflicts of interest or financial ties to disclose.
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Mike G. Laukoetter and Rudolf Mennigen have contributed equally to this work.
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Laukoetter, M.G., Mennigen, R., Neumann, P.A. et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 31, 2687–2696 (2017). https://doi.org/10.1007/s00464-016-5265-3
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DOI: https://doi.org/10.1007/s00464-016-5265-3