Successful repair of duodenal perforation with endoscopic vacuum therapy

Yoo, Timothy; Hou, Linda A.; Reicher, Sofiya; Chen, Kathryn T.; Eysselein, Viktor E.

doi:10.1016/j.gie.2017.11.019

Cited by 13 publications

(11 citation statements)

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“…4 However, vacuum stimulates the healing of leaks and fistulas through granulation tissue's formation and would be very effective also in this setting. [5][6][7] In the present paper, we present the experience of our center in endotherapy of duodenal stump's dehiscence using an innovative application of EVT.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Mutignani

Dioscoridi

Massad

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: The usefulness of endoscopic vacuum therapy (EVT) in the setting of postoperative gastrointestinal leaks is widely described. On this basis, we would like to focus a specific application of EVT: the dehiscence of the duodenal stump after upper gastrointestinal surgery. Standard EVT is not applicable in these cases because of technical limitations (length of overtube and devices). However, vacuum stimulates the healing of leaks and fistulas through granulation tissue’s formation and would be effective also in this setting. Materials and Methods: Between October 2019 and January 2020, 7 consecutive patients (4 M, 3 F, 62±9 y old) affected by duodenal stump’s dehiscence were endoscopically treated by the placement of a large-bore (14 to 18 Ch) suction tube across the wall’s defect into the peritoneal cavity. Continuous aspiration at −80/−100 mm Hg was applied. Clinical success was established both by fluoroscopic check injecting contrast medium from the tube to verify the fistula’s closure and by abdominal computed tomography scan to exclude residual fluid collections. Results: Technical and clinical success were achieved in all the patients. The suction tube was maintained in site for 12±5 days in continuous aspiration. The drainage’s output became null in 2±1 days without any intra-abdominal residual fluid collection. The principle of this technique is to let the duodenal walls’ stump to collapse on the intraluminal part of the tube (with subsequent mucosal intussusception into the holes of the tube itself) creating a sort of vacuum-packed barrier to interrupt the outflow of enteric materials into the fistula’s path. It guarantees the fistula’s closure by the gradual formation of granulation tissue. Conclusions: The present technique offers a safe and viable endoscopic alternative to treat duodenal stump’s leaks after upper gastrointestinal surgery.

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Section: Discussionmentioning

confidence: 99%

“…3,5 Generally, the aspiration is responsible to keep dry the site. Unfortunately, the standard methods of EVT effective in similar settings [5][6][7] are not applicable in this situation because the surgically altered anatomy is not affordable by the regular devices.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Mutignani

Dioscoridi

Massad

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…In addition, compared with endoscopic stenting, EVT was associated with higher AL closure rates, shorter treatment duration, and lower mortality in several meta-analyses of retrospective studies [11,14,20,21]. Other potential indications for EVT, which require specific endoscopic techniques and drain types, include duodenal wall defects [22][23][24][25][26][27] and pancreatic fistula [4,[28][29][30].…”

Section: Indications For Evt In the Upper Gi Tractmentioning

confidence: 99%

Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it

Gutschow

Schlag

Vetter

2022

Langenbecks Arch Surg

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Background Endoscopic vacuum therapy (EVT) has emerged as a novel treatment option for upper gastrointestinal wall defects. The basic principle of action of EVT entails evacuation of secretions, removal of wound debris, and containment of the defect. Furthermore, there is increasing evidence that EVT reduces interstitial edema, increases oxygen saturation, and promotes tissue granulation and microcirculation. Various devices, such as macroporous polyurethane sponge systems or open-pore film drains, have been developed for specific indications. Depending on the individual situation, EVT devices can be placed in- or outside the intestinal lumen, as a stand-alone procedure, or in combination with surgical, radiological, and other endoscopic interventions. Purpose The aim of this narrative review is to describe the current spectrum of EVT in the upper gastrointestinal tract and to assess and summarize the related scientific literature. Conclusions There is growing evidence that the efficacy of EVT for upper GI leakages exceeds that of other interventional treatment modalities such as self-expanding metal stents, clips, or simple drainages. Owing to the promising results and the excellent risk profile, EVT has become the therapy of choice for perforations and anastomotic leakages of the upper gastrointestinal tract in many centers of expertise. In addition, recent clinical research suggests that preemptive use of EVT after high-risk upper gastrointestinal resections may play an important role in reducing postoperative morbidity.

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“…So far, only a few reports have described use of ENPT in cases of duodenal leakages 9 10 11 12 13 14 15 16 17 18 . In this retrospective study, we demonstrate use of ENPT in a population of 11 patients.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic negative pressure therapy (ENPT) for duodenal leakage – novel repair technique using open-pore film (OFD) and polyurethane-foam drainages (OPD)

et al. 2019

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IntroductionIntestinal leakage is often associated with critical illness due to septic condition. The therapeutic aim is to control the septic conditions, focusing on closing the intestinal defect and establishing sufficient drainage [1]. Endoscopic procedures are of increasing importance in management of intestinal defects [2 -4].Initially, negative pressure wound therapy was developed to treat superficial infected wounds. Subsequently intracorporal endoscopic negative pressure therapy (ENPT) (also known as endoscopic vacuum therapy, E-vac therapy, and endo-vac ther-apy) was also found to be effective in healing intracorporal wounds. ENPT was initially used to treat anastomotic insufficiencies in the rectum [5], and was subsequently adapted to treat esophageal leakages [6]. To date, more than 200 patients with transmural defects of the esophagus (anastomotic leaks and perforations) have been treated with a healing rate of 90 % [7,8].So far, only a few reports have described use of ENPT in cases of duodenal leakages [9 -18]. In this retrospective study, we demonstrate use of ENPT in a population of 11 patients. Pertinent information on six patients already has been published in a small primary case series or first case reports [9 -13]. ABSTR AC TBackground and study aims Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages.Patients and methods The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of -125 mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days.Results Eleven patients were treated with duodenal leaks.Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth -1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 -24 days). Complete healing of defects was achieved in all patients.Conclusion ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects.

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Successful repair of duodenal perforation with endoscopic vacuum therapy

Cited by 13 publications

References 0 publications

Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it

Endoscopic negative pressure therapy (ENPT) for duodenal leakage – novel repair technique using open-pore film (OFD) and polyurethane-foam drainages (OPD)

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