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

Endoscopic vacuum therapy for the management of nonvariceal upper gastrointestinal bleeding: a valuable resource for the endoscopist's toolbox

Endoscopic vacuum therapy (EVT) is a well-established method for managing gastrointestinal perforations. During the COVID pandemic, case reports demonstrated the effective use of EVT in controlling COVID-related diffuse duodenal bleeding. Owing to its unique mechanism of action, this approach may also be effective for other types of nonvariceal upper gastrointestinal bleeding (NVUGIB). This study aimed to assess EVT in the treatment of NVUGIB.This retrospective analysis of a prospectively collected database included patients who underwent EVT for the treatment of NVUGIB. The primary outcome was clinical success. Secondary outcomes included technical success and safety. Subgroup analysis comparing the outcomes for patients with and without COVID was conducted.19 patients underwent EVT for NVUGIB, with 57.9% having failed other therapies. Technical success occurred in all patients, and clinical success was achieved in 89.5%. There was no difference in the clinical success rates between patients with or without COVID (88% versus 91%, respectively). No procedure-related adverse events occurred. EVT appears to be safe and effective in the management of NVUGIB. This approach could be particularly useful in refractory or diffuse bleeding. Larger studies are warranted to validate these findings.

Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks: How to Deal with the Challenges (with Video)

Anastomotic leaks after gastrointestinal surgery have an important impact on surgical outcomes because of the high morbidity and mortality rates. Multiple treatment options exist requiring an individualized patient-tailored treatment plan after multidisciplinary discussion. Endoscopic vacuum therapy (EVT) is a novel treatment option that is nowadays recognized as an effective and useful endoscopic approach to treat leaks or perforations in both the upper and lower gastrointestinal tract. EVT has a very good safety profile. However, it is a time-consuming endeavour requiring engagement from the endoscopist and understanding from the patient. To the unexperienced, the EVT technique may be prone to several hurdles which may deter endoscopists from using it and depriving patients from a potentially life-saving therapeutic option. The current review highlights the possible difficulties of the EVT procedure and aims to provide some practical solutions to facilitate its use in daily clinical practice. Personal tips and tricks are shared to overcome the pre-, intra- and post-procedural hurdles. An instructive video of the procedure helps to illustrate the technique of EVT.