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Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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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Author information

MB and SHC have written the manuscript. HF, TH, SB, JML, AHH, and WS have contributed largely to idea and proposal, evaluation and analysis of data. CJB has reviewed the manuscript critically.

Correspondence to Marc Bludau.

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Disclosure

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

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Keywords

  • Esophageal perforation
  • Anastomotic leakage
  • Endoscopic vacuum-assisted closure system