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Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study

Surgical Endoscopy volume 31, pages 2687–2696 (2017)Cite this article

Abstract

Background

Perforations and anastomotic leakages of the upper gastrointestinal (GI) tract cause a high morbidity and mortality rate. Only limited data exist for endoscopic vacuum therapy (EVT) in the upper GI tract.

Methods

Fifty-two patients (37 men and 15 women, ages 41–94 years) were treated (12/2011–12/2015) with EVT for anastomotic insufficiency secondary to esophagectomy or gastrectomy (n = 39), iatrogenic esophageal perforation (n = 9) and Boerhaave syndrome (n = 4). After diagnosis, polyurethane sponges were endoscopically positioned with a total of 390 interventions and continuous negative pressure of 125 mm of mercury (mmHg) was applied to the EVT-system. Sponges were changed endoscopically twice per week. Clinical and therapy-related data and mortality were analyzed.

Results

After 1–25 changes of the sponge at intervals of 3–5 days with a mean of 6 sponge changes and a mean duration of therapy of 22 days, the defects were healed in 94.2 % of all patients without revision surgery. In three patients (6 %), EVT failed. Two of these patients died due to hemorrhage related to EVT. Four postinterventional strictures were observed during the follow-up of up to 4 years.

Conclusion

Esophageal wall defects of different etiology in the upper gastrointestinal tract can be treated successfully with EVT, considering that indication for EVT should be weighed carefully. EVT can be regarded as a novel life-saving therapeutic tool.

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Abbreviations

GI:

Gastrointestinal

EVT:

Endoscopic vacuum therapy

SEMS:

Self-expanding metal stent

SEPS:

Self-expanding plastic stent

CT:

Computed tomography

OTSC:

Over-the-scope clip

WBC:

White blood cell count

CRP:

c-reactive protein

PVC:

Polyvinyl chloride

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Author notes

    Affiliations

    1. Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany

      Mike G. Laukoetter, Rudolf Mennigen, Philipp A. Neumann, Sameer Dhayat, Gabriele Horst, Daniel Palmes, Norbert Senninger & Thorsten Vowinkel

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    1. Mike G. Laukoetter
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    2. Rudolf Mennigen
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    Correspondence to Mike G. Laukoetter.

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    Disclosures

    M.G. Laukoetter is a member of the expert panel of negative pressure wound therapy of the Paul Hartmann (AG) holding company. He received fees for invited speeches on endoscopic vacuum therapy. Drs. R. Mennigen, P.A. Neumann, S. Dhayat, G. Horst, D. Palmes, N. Senninger and T. Vowinkel have no conflicts of interest or financial ties to disclose.

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    Mike G. Laukoetter and Rudolf Mennigen have contributed equally to this work.

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    Laukoetter, M.G., Mennigen, R., Neumann, P.A. et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 31, 2687–2696 (2017). https://doi.org/10.1007/s00464-016-5265-3

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    • DOI: https://doi.org/10.1007/s00464-016-5265-3

    Keywords

    • Endoscopic vacuum therapy
    • Anastomosis
    • Leak
    • Esophageal perforation
    • Postoperative complications
    • Upper gastrointestinal tract