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Endoskopische Vakuumtherapie bei Ösophagusläsionen

Endoscopic vacuum therapy for esophageal defects

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Die endoskopische Therapie von Leckagen und Perforationen im oberen Gastrointestinaltrakt (GI-Trakt) gewinnt zunehmende Bedeutung, da diese die Morbidität und die Mortalität chirurgischer Interventionen signifikant reduziert.

Ziel der Arbeit

In der aktuellen Literatur beschriebene Erfolgsraten der endoskopischen Vakuumtherapie (EVT) im oberen GI-Trakt werden zusammengetragen. Die technischen Aspekte der EVT werden beschrieben. Abschließend erfolgt eine Diskussion zur Bedeutung dieser neuen Therapieoption für Ösophagusläsionen unterschiedlicher Ätiologie.

Material und Methode

Nach endoskopischer Beurteilung der Leckagengeometrie wird ein Polyurethanschaumschwamm in korrespondierender Form zurechtgeschnitten, mit einer Nasensonde konnektiert und endoskopisch in den Defekt vorgeschoben. Eine Vakuumpumpe generiert einen kontinuierlichen Unterdruck von 100–125 mmHg über die Sonde. Dies führt zur effektiven Drainage der Wundhöhle und letztlich zur Wundheilung durch Bildung von Granulationsgewebe. Ein Systemwechsel erfolgt alle 3 bis 5 Tage. Technische Aspekte werden erläutert und grundlegende Literatur hierzu diskutiert.

Ergebnisse

Erste Fallserien belegen die exzellente Heilungsrate mit einer geringen therapieassoziierten Morbidität.

Schlussfolgerung

Diese Therapie wird wahrscheinlich der neue Standard in der Behandlung von Leckagen im oberen GI-Trakt werden.

Abstract

Background

Endoscopic management of leakages and perforations of the upper gastrointestinal tract is gaining in importance as it can significantly reduce the morbidity and mortality of surgical interventions.

Objective

A summary of the current literature with the focus on success rates for endoscopic vacuum therapy (EVT) in the upper gastrointestinal tract is presented. Technical aspects are demonstrated and the role of EVT as a new therapeutic option for esophageal defects of different etiologies is discussed.

Material and methods

After endoscopic assessment of the geometry of the leakage defect a polyurethane foam sponge is cut into the corresponding shape, connected to a nasal gastric tube and endoscopically placed into the defect. Continuous negative pressure of 100–125 mmHg generated by a vacuum pump is applied via the drainage tube resulting in effective drainage of the cavity and the induction of wound healing by formation of granulation tissue. The foam sponge is replaced in the same way every 3–5 days. Technical aspects are demonstrated and the background literature is discussed.

Results

The first series of cases demonstrate excellent healing rates with a very low procedure-related morbidity.

Conclusion

It appears likely that this technique will become the new therapeutic standard for leakages in the upper gastrointestinal tract.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland

    M. G. Laukötter &  N. Senninger

Authors
  1. M. G. Laukötter
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  2. N. Senninger
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Correspondence to M. G. Laukötter.

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Interessenkonflikt

M.G. Laukötter ist Mitglied des Competence Networks für NPWT der Paul Hartmann AG und in dieser Funktion als Berater und Referent tätig. Er erhält hierfür ein Honorar von der Paul Hartmann AG. N. Senninger gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Laukötter, M.G., Senninger, N. Endoskopische Vakuumtherapie bei Ösophagusläsionen. Z Herz- Thorax- Gefäßchir 30, 260–265 (2016). https://doi.org/10.1007/s00398-016-0069-2

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  • DOI: https://doi.org/10.1007/s00398-016-0069-2

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