The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

Smallwood, Nathan; Fleshman, James W.; Leeds, Steven G.; Burdick, J. Steven

doi:10.1007/s00464-015-4501-6

Cited by 106 publications

(52 citation statements)

References 19 publications

(43 reference statements)

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“…With the increased popularity in Europe (Germany) and growing interest in the US, a recent case series by Smallwood et al was reported on six patients with esophageal perforations who were treated with a modified E-vac therapy. All six had successful closure of their esophageal perforation (average duration 35.8 days) as evidenced on both esophagoscopy and CT imaging (48). Alone, and in combination with esophageal stent placement, these techniques provide options for patients with complex esophageal injuries and leaks.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents.Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse J Thorac Dis 2017;9(Suppl 2):S135-S145 jtd.amegroups.com significantly less esophageal dilatation, a lower rate of migration and improved palliation for malignant esophageal strictures and malignant tracheo-esophageal fistulae (10,11). However, placement of these prostheses continued to be reserved only for the patient requiring palliative therapy for a malignancy because of the potential esophageal damage associated with extraction including reports of irreparable, sometimes life threatening, fistulae.To combat these complications, second generation metallic stent designs were developed incorporating a covering of silicone, polyurethane or other polymers (12). While offering the advantage of diminishing amount of tumor ingrowth and fixation to the esophageal wall, it came with the cost of higher migration rates. Later, the ends of these covered stents were modified to be partially covered with a margin of 1.5 cm on both proximal and distal ends to optimize purchase of the esophageal wall (13).Further evolution in esophageal stent biomaterials resulted in the development of an occlusive plastic prosthesis coated with silicone. This new design allowed ease of insertion, a minimal requirement for esophageal dilation and the ability to form an occlusive seal within the lumen of the esophagus (14). The distinctive advantage of these non-metallic endoprostheses was the ability for removal or replacement even after an extended period of time without damage to the esophagus. However, similar to the covered metallic stents, a higher incidence of migration was appreciated (15).These synergistic developments led to a crucial turning point in management of esophageal perforations. The ease in manipulation of high-quality covered, occlusive stents in the esophagus, led some investigators to implant these stents in select patients as a temporary measure to treat intrathoracic anastomotic leaks following esophagogastrostomy and acute perforations. Segalin et al. and Roy-Choudhury et al. were am...

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Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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“…Leak from oesophageal and gastric anastomosis sites and perforations resulting from endoscopic procedures were successfully closed using the E-VAC therapy[59,60]. Application of this device in KT recipients remains to be explored.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the negative pressure wound therapy in kidney transplant recipients

Shrestha¹

2016

WJT

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AIMTo review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.METHODSA systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.RESULTSNo complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.CONCLUSIONNegative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

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“…Successful closure of these defects was reported in between 78 and 100% of the cases. [59][60][61][62] In two series, a subset of patients were managed with a combination of E-VAC therapy and endolumenal stenting with complete healing reported. 61,62 Only one study available to date has specifically investigated the use of E-VAC therapy for the management of staple line leaks following sleeve gastrectomy, and in their series of 9 patients had complete resolution of their leaks confirmed by upper GI series, and 5 of the 9 patients underwent combination therapy with stenting.…”

Section: Nondefinitive Endoscopic Therapymentioning

confidence: 99%

Endoscopic Management of Gastrointestinal Complications

Witte

Pauli

2018

Dig Dis Interv

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Despite improvements in preoperative patient optimization, refinements in surgical methodology and technology, and the implementation of enhanced recovery protocols, complications following gastrointestinal (GI) surgery remain a fact of life. As the rates of GI surgical procedures increase worldwide, so will the volume of complications. The surgical management of complications is often not ideal, as some (such as acute staple line bleeding or the development of an anastomotic stricture) are luminal-based processes that are difficult to approach from an extraluminal (i.e., surgical) perspective. Endoscopy has largely replaced surgery for the management of such postoperative problems. Leak, the most feared complications of GI surgery, can result from intestinal resection, anastomosis formation, or from iatrogenic injury. With advancements in both diagnostic and therapeutic endoscopy, novel endoluminal and transluminal management options for leak continue to evolve. In centers where these interventions are readily available, they are becoming a first-line treatment option. This article will review the endoscopic management of GI complications with a particular focus on the management of postoperative strictures and of full-thickness GI tract defects (perforations, acute leaks, and chronic fistulae).

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The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

Abstract: E-Vac therapy is a promising new method in the treatment of upper gastrointestinal leaks and perforations. Current successes need to be validated through future prospective controlled studies.

Cited by 106 publications

References 19 publications

Endoscopic management of esophageal leaks

Endoscopic management of esophageal leaks

Systematic review of the negative pressure wound therapy in kidney transplant recipients

Endoscopic Management of Gastrointestinal Complications

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