Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study.
Between October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract.
Complete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents.
This study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects.
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Marc Bludau, Hans F. Fuchs, Till Herbold, Felix Popp, Christiane J. Bruns, Arnulf H. Hölscher, Jessica M. Leers, Wolfgang Schröder, Hakan Alakus, Martin K. H. Maus, and Seung-Hun Chon have no conflicts of interest or financial ties to disclose.
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Bludau, M., Fuchs, H.F., Herbold, T. et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc 32, 1906–1914 (2018). https://doi.org/10.1007/s00464-017-5883-4
- Esophageal perforation
- Anastomotic leakage
- Endoscopic vacuum-assisted closure system