Endoscopic vacuum therapy in Boerhaave’s syndrome with open-pore polyurethane foam and a new open-pore film drainage

Loske, Gunnar; Schorsch, Tobias; Ackeren, Vera van; Schulze, Wolfgang; Müller, Christian

doi:10.1055/s-0034-1392597

Cited by 21 publications

(17 citation statements)

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“…In detail, four leaks in the esophagus (two after Ivor-Lewis esophagectomy, one after gastrectomy and one patient with Boerhaave’s perforation 7 ) were healed with ENPT. In three patients ENPT started with OPD.…”

Section: Resultsmentioning

confidence: 96%

“…We have developed a novel open-pore film drainage (OFD) system for vacuum therapy using open-pore film instead of foam. The major advantage of this system is its smaller distal diameter, making it easier to place and manipulate endoscopically 5 6 7 8 . Herein we report our first experience with these small-bore vacuum drainage devices.…”

Section: Introductionmentioning

confidence: 99%

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Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT)

et al. 2018

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Background and study aims Endoscopic negative pressure therapy (ENPT) has been developed to treat gastrointestinal leakages. Up to now, ENPT has usually been performed with open-pore polyurethane foam drains (OPD). A big disadvantage of the OPDs is their large diameter. We have developed a new, small-bore open-pore film drainage (OFD). Herein we report our first experience in a case series of 16 patients. Patients and methods OFD is constructed with a drainage tube and a very thin double-layered open-pore drainage film (Suprasorb CNP, Drainage Film, Lohmann & Rauscher International, Germany). The distal end of the tube is wrapped with only one layer of film. OFD is placed into the gastrointestinal leakage site with common endoscopic techniques. The tube is connected to an electronic vacuum device and continuous negative pressure of –125 mmHg applied. Results From 2013 to 2016, 16 patients were treated with the new OFD device. In 10 patients, transmural intestinal defects (4 esophageal, 4 rectum/colon, 1 duodenal, 1 pancreatic cyst) were closed with ENPT in median time of 12 days (range 3 – 34 days). Five of the 10 patients were treated solely with OFD devices. In five patients ENPT started with ODP and changed to OFD when the cavity was shrunken to a channel with a small opening. In four patients postoperative gastric reflux was eliminated for 5 to 16 days. Conclusions Small-bore OFD opens up promising new treatment options within ENPT. OFD can be used in endoscopic closure management of intestinal leakages in the upper and lower gastrointestinal tract. Gastric reflux can be eliminated in an active manner. OFD can be inserted nasally. OFD may be an adequate substitute for OPD, especially when placement of the larger OPD is difficult.

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Section: Resultsmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT)

et al. 2018

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“…Endoscopy is a proven effective method in the diagnosis of Boerhaave's syndrome, particularly in cases in which the diagnosis is suspected but ndings on CT are inconclusive, because endoscopy enables speci c lesion characterization. Regarding endoscopic treatment, different therapeutic mechanisms can be proposed: closing with over-the-scope-clips [9,10], endoscopic ligation with snare loops [11], derivation indwelling esophageal stent [12,13],and placement of open-pore polyurethane foam or luminal sponge [14,15]. From the perspective of trauma degree, endoscopic management is preserved to treat inoperable patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

Wang

Wang²,

Chen

2020

Preprint

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BACKGROUND: Boerhaave’s syndrome is the spontaneous rupture of the esophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality, which is why it requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging.CASE PRESENTATION: Case one: A 54-year-old man presented to us with sudden-onset epigastric pain radiating to the back following hematemes. His previous medical history included gastric ulcer. His physical signs suggested early shock. Combined with his medical history and physical signs, emergency doctor suspected a diagnosis of peptic ulcer with hematemesis, and esophagegastroscopy was performed. However, upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. The subsequent computed tomography (CT) showed frank pneumomediastinum and heterogeneous pleural effusion. He was subsequently referred to us in view of suspected Boerhaave’s syndrome and clinical worsening. In view of hemodynamic instability with uncontrolled sepsis, he was planned for surgery. Esophageal perforation repair operation and jejunostomy was performed for him. The postoperative period was uneventful, and he was discharged.Case two: A 62-year-old man was admitted to the emergency department with thoracic dull pain and chest distress that started after he had been vomiting several hours before presentation. On physical examination, he presented rough bronchovesicular breathing sound, and crepitant rales in lungs prompting subcutaneous emphysema. Chest CT scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Therefore, spontaneous esophageal perforation was suspected. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His vital signs remained stable intraoperatively, and his postoperative periods were uneventful with no leakage or stricture. Case three: The patient was a 69-year old male presenting with a severe retrosternal and upper abdominal pain followed an episode of forceful vomiting. At admission, he was diaphoretic and in respiratory distress. Physical examination revealed extensive cervical and thoracic subcutaneous emphysema but was otherwise unremarkable. A thoracic CT scan revealed a rupture in the left distal part of the oesophagus, a pneumomediastinum and left-sided pleural effusions. Conservative treatment, with cessation of oral intake, nasogastric suction, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum anti-biotics, proton pump inhibitors and drainage of the pleural effusion by left-sided thoracostomy, failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery.CONCLUSIONS: We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

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“…Впервые данную методику у пациентов с СБ применил Loske G. [49] еще в 2010 году. Малоинвазивность, относительная техническая простота, а также эффективность ЭВТ при разрывах пищевода подтверждаются рядом исследований [50,51], что делает ее выгодной альтернативой уже имеющимся методам лечения.…”

Section: Discussionunclassified

Boerhaave’s syndrome: case report and review

Andreychenko

Александрович²,

Bychinin

et al. 2018

Journal of Clinical Practice

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Well-timed diagnostics of a spontaneous nontraumatic rupture of esophagus or Boerhaave’s syndrome, presents great difficulties because of his rarity and a variety of clinical implications. Esophagus ruptures may feign various organs pathology [2] that most often demands differential diagnostics with a stomach ulcer perforation, acute myocardial infarction, pulmonary artery embolism, aortic dissection and pancreatitis [16, 17]. The treatment can include conservative and surgical tools, but still accompanied by high mortality (up to 35%) [7]; results largely defined by the time between the moment of a rupture and start of the treatment. In addition to the review, described the experience of successful treatment of a patient with Boerhaave’s syndrome in the light of the generalized today data of world medical literature on this problem.

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Endoscopic vacuum therapy in Boerhaave’s syndrome with open-pore polyurethane foam and a new open-pore film drainage

Cited by 21 publications

References 0 publications

Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT)

Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT)

Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

Boerhaave’s syndrome: case report and review

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