“…The advantages of dOFD are its thin diameter, easy insertion into the drain, and the possibility of simultaneous nutrition. PARD can also be carried out using a single-lumen OFD and OPD or a double-lumen OPD [ 13 , 25 ]. Prospective studies comparing these types of open-pore drains with common NGTs would be desirable.…”
Background
Postoperative reflux can compromise anastomotic healing after Ivor-Lewis oesophagectomy (ILE). We report on Pre-emptive Active Reflux Drainage (PARD) using a new double-lumen open-pore film drain (dOFD) with negative pressure to protect the anastomosis.
Methods
To prepare a dOFD, the gastric channel of a triluminal tube (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over 25 cm. The ventilation channel is blocked. The filmcoated segment is placed in the stomach and the intestinal feeding tube in the duodenum. Negative pressure is applied with an electronic vacuum pump (− 125 mmHg, continuous suction) to the gastric channel. Depending on the findings in the endoscopic control, PARD will either be continued or terminated.
Results
PARD was used in 24 patients with ILE and started intraoperatively. Healing was observed in all the anastomoses. The median duration of PARD was 8 days (range 4–21). In 10 of 24 patients (40%) there were issues with anastomotic healing which we defined as “at-risk anastomosis”. No additional endoscopic procedures or surgical revisions to the anastomoses were required.
Conclusions
PARD with dOFD contributes to the protection of anastomosis after ILE. Negative pressure applied to the dOFD (a nasogastric tube) enables enteral nutrition to be delivered simultaneously with permanent evacuation and decompression.
“…The advantages of dOFD are its thin diameter, easy insertion into the drain, and the possibility of simultaneous nutrition. PARD can also be carried out using a single-lumen OFD and OPD or a double-lumen OPD [ 13 , 25 ]. Prospective studies comparing these types of open-pore drains with common NGTs would be desirable.…”
Background
Postoperative reflux can compromise anastomotic healing after Ivor-Lewis oesophagectomy (ILE). We report on Pre-emptive Active Reflux Drainage (PARD) using a new double-lumen open-pore film drain (dOFD) with negative pressure to protect the anastomosis.
Methods
To prepare a dOFD, the gastric channel of a triluminal tube (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over 25 cm. The ventilation channel is blocked. The filmcoated segment is placed in the stomach and the intestinal feeding tube in the duodenum. Negative pressure is applied with an electronic vacuum pump (− 125 mmHg, continuous suction) to the gastric channel. Depending on the findings in the endoscopic control, PARD will either be continued or terminated.
Results
PARD was used in 24 patients with ILE and started intraoperatively. Healing was observed in all the anastomoses. The median duration of PARD was 8 days (range 4–21). In 10 of 24 patients (40%) there were issues with anastomotic healing which we defined as “at-risk anastomosis”. No additional endoscopic procedures or surgical revisions to the anastomoses were required.
Conclusions
PARD with dOFD contributes to the protection of anastomosis after ILE. Negative pressure applied to the dOFD (a nasogastric tube) enables enteral nutrition to be delivered simultaneously with permanent evacuation and decompression.
“…The open-pore film is wrapped and fixed around the distal, perforated part of the gastric decompression tube. This part is placed in front of the defect, and only the gastric decompression tube is connected to the negative pressure pump, while the distal part is placed deep in the duodenum or jejunum to facilitate simultaneous enteral feeding without the need for an additional feeding tube [26, 27].…”
Section: Technical Aspects and Advantages Of Ofdmentioning
<b><i>Background:</i></b> Endoscopic vacuum therapy (EVT) is an increasingly popular endoscopic technique used for the treatment of wall defects in the gastrointestinal tract. Open-pore film drainage (OFD) systems are a new addition to the armamentarium of EVT and have shown encouraging results in a wide spectrum of applications. The aim of this review is to summarize the current literature on the applications of OFD systems in the gastrointestinal tract. <b><i>Summary:</i></b> Open-pore film drainage (OFD) systems have been used for the treatment of several defects of the gastrointestinal tract. The small size and easy placement of these devices make them very useful, particularly for the treatment of defects that are small in size or difficult to reach. OFDs have been successfully used for both perforations and anastomotic leaks in various locations, with most reports focusing on the treatment of duodenal defects, although successful applications in the esophagus, stomach, and colon have also been reported. Lately, the role of OFDs in preemptive EVT has also been explored. <b><i>Key Messages:</i></b> OFD systems are easy to use, particularly for small defects and challenging localizations. The current literature, consisting mainly of small case series and case reports, shows encouraging results, but further prospective studies are needed to explore and verify the indications and technical aspects of this innovative method.
“…The gastral tubes were connected to an electric vacuum pump with pressure monitoring (KCI V.A.C. ® Ultra Therapy Unit, KCI USA Inc., San Antonio, Texas, United States), according to the description of a fashioned device using a two lumen tube as already described [ 15 ]. The predetermined vacuum was 125 mmHg according to the usually used negative pressure for ENPT in the gastrointestinal tract [ 14 ].…”
Section: Case Presentationmentioning
confidence: 99%
“…In the article “Tips and tricks for endoscopic negative pressure therapy” G. Loske introduced different open-pore elements based on the open-pore film (CNP ® -film = Suprasorb CNP ® Drainage Film; Lohmann & Rauscher International GmbH & Co.KG, Rengsdorf, Germany) and polyurethane sponge [ 14 ]. The use of feeding tubes for ENPT in endoluminal position can ensure patients’ enteralization for the duration of therapy [ 15 ]. Fig.…”
Background
Endoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula.
Case presentation
We present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days.
Conclusions
This is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery.
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