Abstract
Background
Anastomotic insufficiency in esophageal anastomosis and esophageal defects of other etiology are very severe complications. For anastomotic insufficiency in the rectum, endoscopic vacuum therapy has already been used successfully. The authors used vacuum therapy for anastomotic defects and other lesions of the esophagus.
Methods
Between November 2006 and September 2009, 10 patients (5 men and 5 women, ages 46–82 years) were treated with endoscopic vacuum sponge therapy for anastomotic insufficiency secondary to esophagectomy or gastrectomy (n = 5), iatrogenic esophageal perforation (n = 2), esophageal wall necrosis (n = 1), Boerhaave’s syndrome (n = 1), and perforation of esophageal cancer (n = 1).
Results
After one to seven changes of the sponge at intervals of 2–7 days and a mean therapy duration of 12 days, the defects were healed in all the surviving patients. During treatment, the patients were fed via an intestinal tube or percutaneous endoscopic gastrostomy (PEG), or enterally past the sponge. One patient died of intercurrent severe colitis. In three cases, a revision laparotomy was necessary at the beginning of treatment. No postinterventional stricture or functional relevant scar formation was observed during a follow-up period of 10–380 days after termination of the vacuum therapy.
Conclusion
Esophageal anastomotic insufficiency and esophageal wall defects of other causes can be treated successfully with endoscopic vacuum sponge therapy.
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Disclosures
Dr. Gunnar Loske and Prof. Dr. Mueller received honoraria for organizing and performing a workshop dealing with vacuum therapy of anastomotic dehiscence following resections in the upper and lower gastro-intestinal tract by BBD Aesculap. T. Schorsch declares no conflict of interest.
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Loske, G., Schorsch, T. & Müller, C. Endoscopic vacuum sponge therapy for esophageal defects. Surg Endosc 24, 2531–2535 (2010). https://doi.org/10.1007/s00464-010-0998-x
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DOI: https://doi.org/10.1007/s00464-010-0998-x