Upper intestinal leaks and perforations are associated with high morbidity and mortality rates. Despite the growing experience using endoscopically placed stents, the treatment of these leaks and perforations remain a challenge. Endoluminal vacuum (E-Vac) therapy is a novel treatment that has been successfully used in Germany to treat upper gastrointestinal leaks and perforations. There currently are no reports on its use in the USA.
E-Vac therapy was used to treat 11 patients with upper gastrointestinal leaks and perforations from September 2013 to September 2014. Five patients with leaks following sleeve gastrectomy were excluded from this study. A total of six patients were treated with E-Vac therapy; these included: (n = 2) iatrogenic esophageal perforations, (n = 1) iatrogenic esophageal and gastric perforations, (n = 1) iatrogenic gastric perforation, (n = 1) gastric staple line leak following a surgical repair of a traumatic gastric perforation, and (n = 1) esophageal perforation due to an invasive fungal infection. Four patients had failed an initial surgical repair prior to starting E-Vac therapy.
All six patients (100 %) had complete closure of their perforation or leak after an average of 35.8 days of E-Vac therapy requiring 7.2 different E-Vac changes. No deaths occurred in the 30 days following E-Vac therapy. One patient died following complete closure of his perforation and transfer to an acute care facility due to an unrelated complication. There were no complications directly related to the use of E-Vac therapy. Only one patient had any symptoms of dysphagia. This patient had severe dysphagia from an esophagogastric anastomotic stricture prior to her iatrogenic perforations. Following E-Vac therapy, her dysphagia had actually improved and she could now tolerate a soft diet.
E-Vac therapy is a promising new method in the treatment of upper gastrointestinal leaks and perforations. Current successes need to be validated through future prospective controlled studies.
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The authors would like to thank Drs. Edson Cheung, Robert Hebeler, Baron Hamman, Albert Henry, Bruce Smith, Howard Derrick, and the entire Trauma/Critical Care Staff (Drs. Michael Foreman, Matthew Lovitt, Laura Petrey, James Carroll, Edward Taylor, and Geoffrey Funk) for their expertise in helping manage these patients; YehShen McShan, BA, Arlen Waclawczyk, BS, and Tammy Fisher, RN, MBA, ACHE for their research related support; and finally, the Seeger Surgical Fund of the Baylor Healthcare System Foundation for financial support of this research study.
Drs. Nathan Smallwood, Steven Leeds, James W. Fleshman, and J. S. Burdick have no conflicts of interest or financial ties to disclose.
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Smallwood, N.R., Fleshman, J.W., Leeds, S.G. et al. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc 30, 2473–2480 (2016) doi:10.1007/s00464-015-4501-6
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