Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy

Kaczmarek, Dominik J.; Heling, Dominik; Gonzalez‐Carmona, Maria A.; Strassburg, Christian P.; Branchi, Vittorio; Matthaei, Hanno; Kalff, Jörg C.; Manekeller, Steffen; Glowka, Tim R.; Weismüller, Tobias J.

doi:10.1186/s12876-021-02000-3

Cited by 7 publications

(5 citation statements)

References 46 publications

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“…The high technical success rate (100%) of the H‐EVT is similar to the OPF and is related to the smaller distal diameter of the system (between 6 and 8 mm), making it easier to place and facilitating endoscopic manipulation 16–20 . The overall clinical success of 88.89% was similar to more traditional EVT systems despite TGID location 7,10–12,14,24,25 . Importantly, overall clinical success and time to defect resolution were not significantly different based on location or classification of defect.…”

Section: Discussionmentioning

confidence: 85%

“…[16][17][18][19][20] The overall clinical success of 88.89% was similar to more traditional EVT systems despite TGID location. 7,[10][11][12]14,24,25 Importantly, overall clinical success and time to defect resolution were not significantly different based on location or classification of defect. While clinical success was not different between endoscopic vs. surgically based defects, H-EVT appeared to have a shorter time to clinical success in endoscopic based defects.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, EVT obviates the need for external drainage 1–3 . Since its first description, 4 EVT has emerged as a promising approach with increased adoption worldwide for the treatment of TGID including esophageal, 2 gastric, 5 small intestinal, 6 biliopancreatic, 7 and colorectal 8 locations. EVT has been shown to be highly effective, regardless of defect size and presence of an associated collection, compared to traditional endoscopic strategies 2,3,8–14 …”

Section: Introductionmentioning

confidence: 99%

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Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Hirsch

McCarty

Santos

et al. 2023

Digestive Endoscopy

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ObjectivesEndoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H‐EVT) for the treatment of TGID.MethodsRetrospective multicenter study including patients who underwent H‐EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure.ResultsA total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H‐EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33–1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H‐EVT placement (HR 0.70; 95% CI 0.55–0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H‐EVT (odds ratio 3.08; 95% CI 1.19–7.95) was a significant predictor of clinical success. Three device‐related adverse events (2.08%) occurred.ConclusionsThe use of the H‐EVT is feasible, safe, and effective for the management of TGID.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Hirsch

McCarty

Santos

et al. 2023

Digestive Endoscopy

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“…(22,31) According to Kaczmarek et al defects with a diameter of less than 10 mm can be either treated with FS-EVT or initial balloon dilation followed by cEVT. (32) This second approach is not routinely applied in our center, with the idea to limit the local trauma to the esophageal wall and adjacent wound cavity.…”

Section: Discussionmentioning

confidence: 99%

Endoluminal vacuum therapy using a new “fistula sponge” in treating defects of the upper gastrointestinal tract – a comparative, retrospective cohort study.

Richter,

Conrad,

Hoffmann

et al. 2024

Preprint

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Background: Anastomotic insufficiencies (AI) and perforations of the upper gastrointestinal tract (uGIT) result in high morbidity and mortality. As treatment options surgical revision, endoscopic stent placement as well as endoluminal vacuum therapy (EVT) have been established. The Eso-Sponge® is the only licensed EVT system with limitations in treating small defects (<10mm). Therefore, a fistula sponge (FS) was established for the treatment of such defects as a new therapeutic approach. Methods: The aim of the study was to compare indications, technical/clinical success rates, and complications in a retrospective, comparative study of both EVT approaches. Between 01/2018 and 01/2021 clinical data of patients undergoing FS-EVT or conventional EVT (cEVT; Eso-Sponge®, Braun Melsungen, Germany) due to AI/perforation of the uGIT were recorded. Indication, diameter of leakage, therapeutic success, and complications during the procedure were assessed. FSs were prepared using a nasogastric tube and a porous drainage film (Suprasorb® CNP, Lohmann & Rauscher, Germany) sutured to the distal tip. Results: A total of 72 patients was included (20 FS-EVT; 52 cEVT). FS-EVT was performed in 60% suffering from AI (cEVT = 68%) and 40% from perforation (cEVT = 32%; p > 0.05). FS-EVT's duration was significantly shorter than cEVT (7.6±12.0d vs. 15.1±14.3d; p = 0.014). The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT (p < 0.001). Therapeutic success was achieved in 90% (FS-EVT) and 91% (cEVT; p > 0.05). Conclusions: EVT comprises an efficient treatment option for transmural defects of the uGIT. In daily clinical practice, fistulas <10 mm with large abscess formations poses a special challenge since intraluminal cEVT usually is ineffective. In these cases, the concept of extraluminal FS placement is safe and effective.

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“…EVT was performed according to previous reports [ 10 , 18 , 21 ]. Depending on the perforation/leakage size and diameter of the esophagus, either a thin open-pore drainage film (EVT film) (Suprasorb CNP drainage film, Lohmann & Rauscher, Neuwied, Germany) or an open-pore polyurethane sponge (EVT sponge) (V.A.C.…”

Section: Methodsmentioning

confidence: 99%

Management of esophageal perforations in infants by endoscopic vacuum therapy: a single center case series

et al. 2022

Self Cite

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Background Endoscopic vacuum therapy (EVT) has become a standard treatment method for esophageal perforations in adults. However, experience with EVT in infants is scarce. In this retrospective case series, we report on four very young infants who were successfully treated with EVT for esophageal perforations of different etiology. Methods Four infants were diagnosed with esophageal perforations on day 7, 32, 35 and 159 of life, respectively. The youngest one was prematurely born in the 31st week of pregnancy weighing 980 g only. Three infants had perforations due to foreign body insertion (nasogastric tube or pulling through of percutaneous endoscopic gastrostomy (PEG) tube through the esophagus). One child had an anastomotic dehiscence after Foker’s surgery for atresia. In three children EVT was applied as first-line therapy for perforation, in one child EVT was a rescue therapy due to persisting leakage after surgical closure involving thoracotomy. Depending on the esophageal diameter, either an open-pore drainage film or polyurethane sponge was attached to a single-lumen 8 Fr suction catheter, endoscopically (or fluoroscopically by wire-guidance) placed into the esophagus (intraluminal EVT) and supplied with continuous negative pressure (ranging between 75 and 150 mmHg). The EVT system was exchanged twice per week. Results Complete closure of the perforation/leakage could be achieved in all four infants (100%) after 22 days of continuous EVT (median value; range 7–39) and 4.5 EVT exchanges (median value; range 1–12). No serious adverse events occurred. Conclusions EVT is an effective and safe addition to our therapeutic armamentarium in the management of esophageal perforations irrespective of its etiology. Here we prove the feasibility of EVT even in very young infants. The use of an extra thin vacuum open-pore drainage film is helpful to cope with the small esophageal diameter. EVT settings and exchange rates similar to those known from adult treatment were used.

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Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy

Cited by 7 publications

References 46 publications

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Endoluminal vacuum therapy using a new “fistula sponge” in treating defects of the upper gastrointestinal tract – a comparative, retrospective cohort study.

Management of esophageal perforations in infants by endoscopic vacuum therapy: a single center case series

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