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Jung CFM, Binda C, Tuccillo L, Secco M, Gibiino G, Liverani E, Petraroli C, Coluccio C, Fabbri C. New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration. J Clin Med 2024; 13:4877. [PMID: 39201020 PMCID: PMC11355382 DOI: 10.3390/jcm13164877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter.
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Affiliation(s)
- Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
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Kim JY, Chung H. Endoscopic Intervention for Anastomotic Leakage After Gastrectomy. J Gastric Cancer 2024; 24:108-121. [PMID: 38225770 PMCID: PMC10774755 DOI: 10.5230/jgc.2024.24.e12] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/17/2024] Open
Abstract
Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.
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Affiliation(s)
- Ji Yoon Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea.
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Staudenmann D, Choi KKH, Kaffes AJ, Saxena P. Current endoscopic closure techniques for the management of gastrointestinal perforations. Ther Adv Gastrointest Endosc 2022; 15:26317745221076705. [PMID: 35252863 PMCID: PMC8891873 DOI: 10.1177/26317745221076705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
Acute gastrointestinal perforations occur either from spontaneous or iatrogenic
causes. However, particular attention should be made in acute iatrogenic
perforations as timely diagnosis and endoscopic closure prevent morbidity and
mortality. With the increasing use of diagnostic endoscopy and advances in
therapeutic endoscopy worldwide, the endoscopist must be able to recognize and
manage perforations. Depending on the size and location of the defect, a variety
of endoscopic clips, stents, and suturing devices are available. This review
aims to prepare and guide the endoscopist to use the right tools and techniques
for optimal patient outcomes.
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Affiliation(s)
- Dominic Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Praxis Intesto, Bern, Switzerland; Université de Fribourg, Fribourg, Switzerland
| | - Kevin Kyung Ho Choi
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Arthur John Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, 50 Missenden Road, Sydney, NSW 2050, Australia
- The University of Sydney, Sydney, NSW, Australia
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Nutritional Support and Duration of Drainage Recommendations for Endoscopic Internal Drainage: Review of the Literature and Initial Experience. Obes Surg 2022; 32:1421-1427. [PMID: 35218510 DOI: 10.1007/s11695-022-05978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Anastomotic leaks following foregut surgery pose a difficult scenario for surgeons. While definitive surgical options are more invasive and may result in diversion requiring subsequent surgeries, endoscopic management of these leaks has been shown to work as an alternative platform for management. An evolving option is endoscopic internal drainage. We have reviewed our experience using endoscopic internal drainage and report our outcomes. MATERIALS AND METHODS An institution review board approved prospectively gathered database was used to identify all patients undergoing endoscopic internal drainage following esophageal and gastric leaks. Patient demographics, sentinel operation causing the leak, and outcomes of therapy were collected. The rate of healing and complications with the drainage catheter in place were the primary endpoints. RESULTS Sixteen patients were identified (5 male, 11 female) that underwent endoscopic internal drainage with a mean age of 48 and mean BMI of 30.8. Overall success rate was 69% (11/16), where 4 patients required a definitive surgery, and one healed with endoluminal vacuum therapy. Of the 4 failures, 1 patient required esophagojejunostomy, 2 patients required a fistulojejunostomy, and one required a partial gastrectomy. A total of 12 patients (75%) had a prior endoscopic procedure that was unsuccessful. The mean duration of drainage catheter in place was 48 days. While the catheter was in place, 4 patients were allowed minimal PO intake in conjunction with total parenteral nutrition or tube feeds. The rest of the patients were strict NPO with other means of nutrition. There were no complications with the drainage catheters and no deaths. CONCLUSION Leaks following esophagogastric surgery are difficult to manage; however, endoscopic internal drainage has been shown to be effective. Duration of the technique should be around 6 to 8 weeks with nutritional support guided by the comfort of the managing clinician.
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Laopeamthong I, Akethanin T, Kasetsermwiriya W, Techapongsatorn S, Tansawet A. Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis. Visc Med 2022; 38:63-71. [PMID: 35295893 PMCID: PMC8874239 DOI: 10.1159/000518946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Several endoscopic methods can be employed to manage post-bariatric leaks. However, endoluminal vacuum therapy (EVT) and endoscopic internal drainage (EID) are relatively new methods, and studies regarding these methods are scarce. We performed a systematic review of the literature and a meta-analysis to evaluate the efficacy of EVT and EID. Methods Databases were searched for eligible studies. The clinical success of leak closure was the primary outcome of interest. A proportional meta-analysis was performed for pooling the primary outcome using a fixed-effects model. A meta-analysis or descriptive analysis of other outcomes was performed based on the data availability. Results Data from 3 EVT and 10 EID studies (n = 279) were used for evidence synthesis. The leak closure rates (95% confidence interval [CI]) of EVT and EID were 85.2% (75.1%-95.4%) and 91.6% (88.1%-95.2%), respectively. The corresponding mean treatment durations (95% CI) were 28 (2.4-53.6) and 78.4 (50.1-106.7) days, respectively. However, data about other outcomes were extremely limited; thus, a pooled analysis could not be performed. Conclusions Both EVT and EID were effective when used as the first-line treatment for post-bariatric leaks. However, larger studies must be conducted to compare the efficacy of the 2 interventions.
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Affiliation(s)
- Issaree Laopeamthong
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - Wisit Kasetsermwiriya
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Suphakarn Techapongsatorn
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand,*Amarit Tansawet,
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Toh BC, Chong J, Yeung BP, Lim CH, Lim EK, Chan WH, Tan JT. Endoscopic Internal Drainage with Double Pigtail Stents for Upper Gastrointestinal Anastomotic Leaks: Suitable for All Cases? Clin Endosc 2022; 55:401-407. [PMID: 34986605 PMCID: PMC9178146 DOI: 10.5946/ce.2021.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining ten patients, nine (90%) did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the first week and a soft diet in the second week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.
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Affiliation(s)
- Bin Chet Toh
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Jingli Chong
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Baldwin Pm Yeung
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Eugene Kw Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Th Tan
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
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Allaway MGR, Morris PD, B Sinclair JL, Richardson AJ, Johnston ES, Hollands MJ. Management of Boerhaave syndrome in Australasia: a retrospective case series and systematic review of the Australasian literature. ANZ J Surg 2020; 91:1376-1384. [PMID: 33319446 DOI: 10.1111/ans.16501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Boerhaave syndrome is a rare and life-threatening condition characterized by a spontaneous transmural tear of the oesophagus. There remains wide variation in the condition's management with non-operative management (NOM) and surgery being the two main treatment strategies. The aim was to review the presentation, management and outcomes for patients treated for Boerhaave syndrome at our institution and to compare these data with that previously reported within the Australasian literature. METHODS A retrospective case series was performed for consecutive patients diagnosed with Boerhaave syndrome at our institution between January 2000 and January 2020. A systematic review of the Australasian literature was also performed. RESULTS In case series, 15 patients were included (n = 2 NOM, n = 13 operative). The most common operative technique was primary repair with intercostal drainage via thoracotomy. Major complications occurred in 11 (73%) patients. Median Comprehensive Complication Index was 53.4 (interquartile range: 50). There was a significantly lower Comprehensive Complication Index associated with primary repair when compared to oesophageal resection (P = 0.01). There was one death, in the operative management group. Median length of hospital stay was 33 days (interquartile range: 58). In systematic review, 11 articles were included; four case series and seven case reports. From these, 23 patients met inclusion criteria. The majority of patients (83%) were managed operatively, with only four undergoing NOM. Seven patients died, representing an overall mortality rate of 30%. CONCLUSIONS We provide an updated overview of the management of Boerhaave syndrome within Australasia. Aggressive operative management is associated with reasonable outcomes.
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Affiliation(s)
- Matthew G R Allaway
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul D Morris
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jane-Louise B Sinclair
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Arthur J Richardson
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Emma S Johnston
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael J Hollands
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Gastric leak after laparoscopic sleeve gastrectomy: management with endoscopic double pigtail drainage. A systematic review. Surg Obes Relat Dis 2019; 15:1414-1419. [PMID: 31023576 DOI: 10.1016/j.soard.2019.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 01/28/2023]
Abstract
Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. Good results have been reported using endoscopic double-pigtail stent. To estimate its effectiveness, we carried out this systematic review. Eleven eligible articles were identified by searching PubMed, Embase, and Cochrane Library databases. A total of 385 patients met the inclusion criteria. The pooled proportion of successful leak closures by using double pigtail drainage was 83.41%. The proportion of successful leak closures by using double pigtail drainage by experienced operators as first-line treatment was 84.71%. Our review suggested that double-pigtail stent could be a valid approach to manage the postbariatric gastric leak, with low rate of complications and a good tolerance by patients. More high-quality studies with large samples sizes should be undertaken to better evaluate and compare the variety of techniques available.
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Lin M, Firoozi N, Tsai CT, Wallace MB, Kang Y. 3D-printed flexible polymer stents for potential applications in inoperable esophageal malignancies. Acta Biomater 2019; 83:119-129. [PMID: 30366130 DOI: 10.1016/j.actbio.2018.10.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 01/19/2023]
Abstract
Palliation therapy for dysphagia using esophageal stents is the current treatment of choice for those patients with inoperable esophageal malignancies. However, the metallic and plastic stents currently used in the clinical setting may cause complications, such as tumor ingrowth and stent migration into the stomach. To effectively reduce/overcome these complications, we designed a tubular, flexible polymer stent with spirals. The parameters of the spirals were computationally optimized by using a finite element analysis. The designed polymer stents with optimized spirals were then printed by a 3D printing technique. 3D-printed tubular polymer stents without spirals served as controls. The self-expansion and anti-migration properties of the printed stent were characterized in an ex vivo normal porcine esophagus. The biodegradability test of the stent was performed in a neutral buffer and acidic gastric buffer. The cytotoxicity of the new stent was examined through the viability test of human esophagus epithelial cells. Results showed the self-expansion force of the 3D-printed polymer stent with spirals was higher than the stent without spirals. The anti-migration force of the 3D-printed stent with spirals was significantly higher than that of the stent without spirals. Furthermore, the stent with spirals significantly decreased the migration distance compared to the non-spiral 3D-printed polymer stent. Degradation study showed that the polymer materials started to degrade after six weeks and the compressive strength of the stent was not significantly decreased with time. In vitro cell viability results further indicated that the polymer stent does not have any cytotoxicity. Together, these results showed that the 3D-printed stent with spirals has potential applications in the treatment of inoperable esophageal malignancies. STATEMENT OF SIGNIFICANCE: In this study, we developed a new 3D-printed flexible tubular polymeric stent with spirals. The mechanical properties of the 3D-printed polymer stent are modulated by changing the ratios of PLA to TPU. The stent is flexible enough to be compressed in a clinically available stent delivery system, and can self-expand after it is released. The self-expansion force of the stent with spirals is higher than that of non-spiral stents. The spirals on the outside of the stent significantly increased the anti-migration force compared to non-spiral stents in an ex vivo normal pig esophagus. Together, the 3D-printed stent with spirals will bring promising potential in the treatment of inoperable esophagus malignancies or benign strictures.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Negar Firoozi
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yunqing Kang
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA; Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA.
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Bemelman WA, Baron TH. Endoscopic Management of Transmural Defects, Including Leaks, Perforations, and Fistulae. Gastroenterology 2018; 154:1938-1946.e1. [PMID: 29454791 DOI: 10.1053/j.gastro.2018.01.067] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 02/06/2023]
Abstract
Transmural defects of the gastrointestinal tract can be classified into 3 distinct entities-leak, perforation, and fistula. Each arises from different mechanisms and is managed accordingly. Leaks occur most often after surgery, while perforations occur most often after flexible endoscopic maneuvers. Fistulae arise from a variety of mechanisms, such as an evolution from surgical leaks, as well as from specific disease states. Endoscopic management plays a vital role in the treatment of transmural defects as long as the region of interest can be accessed with the appropriate endoscopic accessories. Endoscopic approaches can be broadly classified into those that provide closure and those that provide diversion of luminal contents. With advances in technology, a myriad of devices and accessories are available that allow a tailored approach. Endoscopic approaches to leaks, perforations, and fistulae are discussed in this review.
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Affiliation(s)
- Willem A Bemelman
- Department of Surgery, The Academic Medical Center and University of Amsterdam, Amsterdam, The Netherlands
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill North Carolina. todd_baron.@med.unc.edu
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Affiliation(s)
- Howard S Fan
- Department of Surgery, University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
| | - Michael L Talbot
- Department of Surgery, University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
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12
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Ooi G, Burton P, Packiyanathan A, Loh D, Chen R, Shaw K, Brown W, Nottle P. Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. ANZ J Surg 2016; 88:E257-E263. [PMID: 27860126 DOI: 10.1111/ans.13837] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic vacuum-assisted closure (EndoVAC) therapy is a recent innovation described for use in upper gastrointestinal perforations and leaks, with reported success of 80-90%. It provides sepsis control and collapses the cavity preventing stasis, encouraging healing of the defect. Whilst promising, initial reports of this new technique have not established clear indications, feasibility and optimal technique. METHODS We analysed all patients who underwent EndoVAC therapy between 2014 and 2016. The technique involved a standard gastroscope, nasogastric tube and vacuum-assisted closure dressing kit, with endoscopic placement of the polyurethane sponge. Data were collected on indication, technique, sepsis control, outcomes and drainage volumes. RESULTS Ten patients were treated. Average age was 56.7 ± 12.3 years. There were three mortalities. EndoVAC placement was feasible in nine patients and successful healing was observed in six patients. Failure was more likely in the cases of large (>8 cm), chronic or complex cavities. A three-phase response was seen in successful cases, with initial reduction in external drainage (average: 143-17 mL/day within 1 week), followed by a progressive reduction in inflammatory markers (2 weeks) and finally a healing phase with reduction in cavity size (3 weeks). CONCLUSION EndoVAC therapy is a potentially useful adjunct to conventional treatments of a subset of upper gastrointestinal leaks and perforations when there is a contained cavity <8 cm. It appears less effective in an uncontained perforation or chronically established tract. It has clear advantages of being easily applied with readily available equipment and disposables.
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Affiliation(s)
- Geraldine Ooi
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - Paul Burton
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - Andrew Packiyanathan
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Damien Loh
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Richard Chen
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kalai Shaw
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Wendy Brown
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - Peter Nottle
- Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
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