Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations

Abstract

Background Although endoscopic vacuum therapy (EVT) has been successfully used to treat postoperative upper gastrointestinal (UGI) wall defects, its use demands special materials and several endoscopic treatment sessions. Herein, we propose a technical modification of EVT using a double tube (tube-in-tube drain) without polyurethane sponges for the drainage element. The tube-in-tube drainage device enables irrigation and application of suction. A flowchart for standardizing the management of postoperative UGI wall defects with this device is presented. Methods An EVT modification was made to achieve frequent fistula cleansing, with 3 % hydrogen peroxide rinsing, and the application of negative pressure. A tube-in-tube drain without polyurethane sponges can be inserted like a nasogastric tube or passed through a previously positioned surgical drain. This was a retrospective two-center observational study, with data collected from 30 consecutive patients. Technical success, clinical success, adverse events, time under therapy, interval time from procedure to fistula diagnosis and treatment start, size of transmural defect, volume of cavity, number of endoscopic treatment sessions, and mortality were reviewed. Results 30 patients with UGI wall defects were treated. The technical and clinical success rates were 100 % and 86.7 %, respectively. Three patients (10 %) had adverse events and three patients (10 %) died. The median time under therapy was of 19 days (range 1–70) and the median number of endoscopic sessions was 3 (range 1–9). Conclusions This standardized approach and EVT modification using a tube-in-tube drain, with frequent fistula cleansing, were successful and safe in a wide variety of UGI wall defects.

Failure to Rescue After Gastrectomy: A New Indicator of Surgical Quality

“…In our institution dedicated to cancer treatment, we constantly seek improvements in perioperative care, nutritional support, and training of the multidisciplinary team. In recent years, several publications of our results have already confirmed the quality of surgical care in complications 7 , 10 , 16 . However, the analysis of our FTR has not yet been carried out to determine and identify its main causes to guide new actions to improve our results.…”

“…On the other hand, the fistula of the esophagojejunal anastomosis is exclusive to patients submitted to total resection. For many years, it was the most feared by surgeons; however, recent advances, such as the use of prostheses and endoscopic vacuum therapy, have greatly reduced its lethality 10 , 16 .…”

Tube‐in‐tube endoscopic vacuum therapy for treatment of colorectal anastomotic leaks: A low‐cost, patient‐friendly, feasible and efficient technical modification of sponge‐based endoscopic vacuum therapy

“…Two tubes are used, one inside the other, allowing the inner to aspirate while the outer precludes clogging. Both tubes must be perforated at the same level, using an 18 gauge needle [9]. Notwithstanding the disadvantage of the lack of a specific tube designed to perform TT‐EVT, it is an advantage that all aspirating systems are self‐made, fashioned for that specific patient and with exact required length.…”

Comments on „Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations”

“…We read with great interest the article by de Lima et al on the application of endoscopic vacuum therapy (EVT) to upper gastrointestinal perforations [1]. We have experienced and previously published the technique in the same setting (for postoperative esophageal leaks) [2] and for chronic duodenal leaks [3], and would like to discuss a few points on the basis of our expertise.…”