Endoscopic Intraluminal Vacuum Therapy of Complete Esophageal-Jejunal Anastomotic Rupture: A Case Report

Loske, Gunnar; Schorsch, Tobias

doi:10.1159/000328082

Cited by 9 publications

(10 citation statements)

References 10 publications

(9 reference statements)

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“…For > 10 years, EVT has been used with promising results for anastomotic break-down after colon resections [6]. After these encouraging results, it has since been used for leak management in the upper GI tract [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks

et al. 2020

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Introduction: Management of esophageal anastomotic leaks (AL) and esophageal perforations (EP) remains difficult and often requires an interdisciplinary treatment modality. For primary endoscopic management, self-expanding metallic stent (SEMS) placement is often considered first-line therapy. Recently, endoscopic vacuum therapy (EVT) has emerged as an alternative or adjunct for management of these conditions. So far, data for EVT in the upper gastrointestinal-tract is restricted to single centre, non-randomized trials. No studies on optimal negative pressure application during EVT exist. The aim of our study is to describe our centre’s experience with low negative pressure (LNP) EVT for these indications over the past 5-years. Patients and Methods: Between January 2014 and December 2018, 30 patients were endoscopically treated for AL (n = 23) or EP (n = 7). All patients were primarily treated with EVT and LNP between –20 and –50 mm Hg. Additional endoscopic treatment was added when EVT failed. Procedural and peri-procedural data, as well as clinical outcomes including morbidity and mortality, were analysed. Results: Clinical successful endoscopic treatment of EP and AL was achieved in 83.3% (n = 25/30), with 73.3% success using EVT alone (n = 22/30). Mean treatment duration until leak closure was 16.1 days (range 2–58 days). Additional treatment modalities for complete leak resolution was necessary in 10% (n = 3/30), including SEMS placement and fibrin glue injection. Mean hospital stay for patients with EP was shorter with 33.7 days compared to AL with 54.4 days (p = 0.08). Estimated preoperative 10-year overall survival (Charlson comorbidity score) was 39.4% in patients with AL and 59.9% in patients with EP (p = 0.26). A mean of 5.1 EVT changes (range 1–12) was needed in EP and 3.6 changes (range 1–13) in AL to achieve complete closure, switch to other treatment modality, or reach endoscopic failure (p = 0.38). Conclusion: LNP EVT enables effective minimally – invasive endoluminal leak closure from anastomotic esophageal leaks and EP in high-morbid patients. In this study, EVT was combined with other endoscopic treatment options such as SEMS placement or fibrin glue injection in order to achieve leak or perforation closure in the vast majority of patients (83.3%). Low aspiration pressures led to slower but still sufficient clinical results.

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Section: Introductionmentioning

confidence: 99%

“…The largest cohort is reported by Bludau et al [11] with 77 patients. The use of EVT started in Germany, propagated by Wedemeyer and Loske et al [7,8,12,13]. In the beginning, the EVT sponges had to be manually prepared and assembled by the treating physician.…”

Section: Introductionmentioning

confidence: 99%

Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks

et al. 2020

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“…ENPT is an effective endoscopic and minimally invasive option for the management of anastomotic insu ciencies of the upper and lower gastrointestinal tract [6-8, 11-14, 21]. First case reports about ENPT for the treatment of EJAL were given by G. Loske [4] and J. Wedemeyer and G. Loske [8]. From these rst reports to the current time overall around 55 cases of EJAL treated with ENPT have been published.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic negative pressure therapy (ENPT) has become a promising tool for managing complications after surgery in both the upper or lower gastrointestinal tract [4][5][6][7][8]. ENPT improves local perfusion, resolution of interstitial wound edema, removal of uids, and debridement of the wound ground [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Combined Endoscopic Negative Pressure and Surgical Treatment of Anastomotic Insufficiencies following Oncological Gastrectomy – Recent Results

Wichmann¹,

Stüker²,

Thiel³

et al. 2020

Preprint

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Background and study aims: Management of esophago-jejunal anastomotic leakages (EJAL) following gastrectomy is challenging. Endoscopic negative pressure therapy (ENPT) is an emerging effective tool for treatment of gastrointestinal and anastomotic leaks. We have been using ENPT as first line therapy for EJAL after oncological gastric resections since 2018. The aim of the study was to present our results with this strategy in a case series. Methods: Nine consecutive patients were treated with ENPT for EJAL after oncological gastrectomy between 01.2018 and 12.2019. A retrospective analysis of patients’ and treatment-related data was performed. Results: Time to leakage detection was 6.00 ± 2.49 days after surgery. After 14.78 ± 9.66 days of ENPT, 6.25 ± 3.65 endoscopies and 38.11 ± 16.46 days of hospitalization, endoscopic treatment with ENPT combined with surgical debridement and drainage for sepsis control was effective in eight of nine patients. In one patient with a complete anastomotic dehiscence, treatment was changed to a stent-based therapy combined with surgery. Conclusions: ENPT is a new and promising option in the complication management of patients with anastomotic insufficiencies following oncological gastrectomy. It can be recommended in combination with limited surgery to preserve the anastomosis and provide sepsis control. The time interval to diagnosis and the size of the insufficiency are important for the success of ENPT in patients with EJAL.

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“…A further development in the esophagus is referred to as “pre-emptive ENPT”. If a suspicious anastomosis is found during follow-up endoscopy after esophageal resection, then intraluminal ENPT is performed even before a defect forms [ 44 , 45 ]. Neumann et al.…”

Section: Enpt In the Esophagusmentioning

confidence: 99%

Endoscopic negative pressure therapy of the upper gastrointestinal tract

Loske

2018

Chirurg

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Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.

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Endoscopic Intraluminal Vacuum Therapy of Complete Esophageal-Jejunal Anastomotic Rupture: A Case Report

Cited by 9 publications

References 10 publications

Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks

Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks

Combined Endoscopic Negative Pressure and Surgical Treatment of Anastomotic Insufficiencies following Oncological Gastrectomy – Recent Results

Endoscopic negative pressure therapy of the upper gastrointestinal tract

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