The prophylactic use of endoscopic vacuum therapy for anastomotic dehiscence after rectal anterior resection: is it feasible for redo surgery?

Mandarino, Francesco Vito; Barchi, Alberto; Biamonte, Paolo; Esposito, Dario; Azzolini, Francesco; Fanti, Lorella; Danese, Silvio

doi:10.1007/s10151-021-02566-w

Cited by 14 publications

(10 citation statements)

References 3 publications

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“…EVT is an emerging technique, providing promising results; future directions could include its use at the time of surgery for prophylactic purposes [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis

Mandarino

Barchi

D’Amico

et al. 2023

Life

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Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the “gold standard” for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. Methods: A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. Results: Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43–4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08–6.71), shorter treatment duration (pmd −9.18, 95% CI −17.05- −1.32), lower short-term complication (OR 0.35, 95% CI 0.18–0.71) and mortality rates (OR 0.47, 95% CI 0.24–0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74–3.40, I2 = 0%). Conclusions: Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks.

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“…EVT is an emerging technique, providing promising results; future directions could include its use at the time of surgery for prophylactic purposes [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis

Mandarino

Barchi

D’Amico

et al. 2023

Life

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“…Loske et al [70] suggested the preemptive use of EVT in order to evacuate reflux from the anastomotic region as this is believed to relevantly contribute to development of upper GI AL. Important data for regular use of preemptive EVT in colorectal setting is lacking; however, some centers report to apply on an irregular basis [71,72].…”

Section: Evt Initiation and Planned Therapy Terminationmentioning

confidence: 99%

Endoscopic Treatment Options for Gastrointestinal Leaks

Drefs¹,

Schardey²,

Ehrlich-Treuenstätt³

et al. 2022

Visc Med

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Background: Spontaneous or postoperative gastrointestinal defects are still life-threatening complications with elevated morbidity and mortality. Recently, endoscopic treatment options – up and foremost endoscopic vacuum therapy (EVT) – have become increasingly popular and have shown promising results in these patients. Methods: We performed an electronic systematic search of the MEDLINE databases (PubMed, EMBASE, and Cochrane) and searched for studies evaluating endoscopic options for the treatment of esophageal and colorectal leakages and/or perforations until March 2022. Results: The closure rate of both esophageal and colorectal defects by EVT is high and even exceeds the results of surgical revision in parts. Out of all endoscopic treatment options, EVT shows most evidence and appears to have the highest therapeutic success rates. Furthermore, EVT for both indications had a low rate of serious complications without relevant in-hospital mortality. In selected patients, EVT can be applied without fecal diversion and transferred to an outpatient setting. Conclusion: Despite multiple endoscopic treatment options, EVT is increasingly becoming the new gold standard in endoscopic treatment of extraperitoneal defects of the upper and lower GI tract with localized peritonitis or mediastinitis and without close proximity to major blood vessels. However, further prospective, comparative studies are needed to strengthen the current evidence.

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“…Beyond FGIDs, gut microbiota also plays a critical role in the pathogenesis of organic diseases of the digestive tract, such as inflammatory bowel diseases [30][31][32], eosinophilic esophagitis [33], and others [34], as well as in the development of post-surgical complications [35,36], which require endoscopic treatment [37][38][39][40][41]. Characterization of the microbiota may represent a future therapeutic approach for these conditions as well.…”

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confidence: 99%