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Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract

Abstract

Background

Postoperative, iatrogenic or spontaneous upper gastrointestinal defects result in significant morbidity and mortality of the patients. In the last few years, endoscopic vacuum therapy (EVT) has been recognized as a new promising method for repairing upper gastrointestinal defects of different etiology. However, probably due to insufficient data and no commercially available system for EVT of the upper gastrointestinal tract, until the end of 2014, covering of esophageal defects with self-expanding metal stents (SEMS) were still the mainstay of endoscopic therapy. The aim of this article is to review the data available about EVT for various upper gastrointestinal defects.

Methods

A selective literature search was conducted in Medline and PubMed (2007–2016), taking into account all the published case series and case reports reporting on the use of EVT in the management of upper gastrointestinal defects.

Results

EVT works through intracorporal application of negative pressure at the defect zone with an electronic controlled vacuum device along a polyurethane sponge drainage. This results in closure of the esophageal defect and internal drainage of the septic focus, simultaneously. Compared to stenting, EVT enables regular viewing of wound conditions with control of the septic focus and adjustment of therapy. Moreover, endoscopical negative pressure is applicable in all esophageal regions (cricopharygeal, tubular, gastroesophageal junction) and in anastomotic anatomic variants. EVT can be used solely as a definite treatment or as a complimentary therapy combined with operative revision. In total, there are published data of more than 200 patients with upper gastrointestinal defects treated with EVT, showing succes rates from 70–100%.

Conclusion

The available data indicate that EVT is feasible, safe and effective with good short-term and long-term clinical outcomes in the damage control of upper GI-tract leaks. Still, a prospective multi-center study has to be conducted to proof the definite benefit of EVT for patients with esophageal defects.

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Author contributions

FK has drafted the manuscript. GL, MG, LS and EK have done substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; GL, MG, LS and EK have revised the article critically for important intellectual content; the article has been approved to be published.

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Correspondence to Florian Kuehn.

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Disclosures

Gunnar Loske is a consultant for Lohmann & Rauscher GmbH & Co. KG. Florian Kuehn, Leif Schiffmann, Michael Gock and Ernst Klar state that there are no conflicts of interest regarding this article.

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Kuehn, F., Loske, G., Schiffmann, L. et al. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc 31, 3449–3458 (2017). https://doi.org/10.1007/s00464-016-5404-x

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  • DOI: https://doi.org/10.1007/s00464-016-5404-x

Keywords

  • Endoscopic vacuum therapy
  • Negative pressure therapy
  • Anastomotic leakage
  • Perforation
  • Upper gastrointestinal tract
  • Endoscopy