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Hustak R. How to close mucosal incisions? Best Pract Res Clin Gastroenterol 2024; 71:101938. [PMID: 39209420 DOI: 10.1016/j.bpg.2024.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/20/2024] [Accepted: 06/04/2024] [Indexed: 09/04/2024]
Abstract
This article provides an overview of the techniques for closure of the mucosal entry point following advanced procedures in the third space. The outbreak of natural orifice transluminal endoscopic surgery (NOTES) has significantly impacted the treatment of various benign and malignant conditions. Reliable and secure closure of the mucosal entrance is essential for avoiding serious adverse events. Although small defects are typically closed using through-the-scope clips (TTSCs) or over-the-scope clips (OTSCs), challenges may occur with larger or transmural defects. Alternative methods, such as specialised stitches and full-thickness suturing systems, have been developed to address these challenges with promising results. Each method has its own pros and cons, and the choice of closure technique depends on various factors such as anatomical location, endoscopist expertise, costs, and clinical context. By understanding the technical specifications of each closure device, endoscopists can make decisions that enhance patient outcomes and minimise the risk of complications associated with the approximation of defect edges. Continued research is essential to optimise the evolution of newer closure devices and techniques for advancing NOTES.
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Affiliation(s)
- Rastislav Hustak
- Gastroenterology Department, University Hospital Trnava, Faculty of Health Care and Social Work, Trnava, A. Zarnova 11, Slovak Republic.
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de Moura DTH, Hirsch BS, Ribas PHBV, Silveira SQ, Guedes HG, Bestetti AM. Endoscopic vacuum therapy: pitfalls, tips and tricks, insights, and perspectives. Transl Gastroenterol Hepatol 2024; 9:50. [PMID: 39091653 PMCID: PMC11292076 DOI: 10.21037/tgh-23-86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/03/2024] [Indexed: 08/04/2024] Open
Abstract
This article provides a comprehensive review of the use of endoscopic vacuum therapy (EVT) in the management of transmural gastrointestinal (GI) defects (TGIDs) and its future perspectives, such as pre-emptive EVT and novel indications, including GI bleeding and large gastroduodenal ulcers management. This review is based on the available literature data and personal experience to demystify the mentioned limitations of EVT as technical difficulties related to the procedure, possible patients' complaints, and institutions' concerns, by sharing several tips and tricks to overcome EVT-related challenges that may discourage endoscopists from using this live-saving technique, and consequently, restricting patients to receive this therapy, which may lead to undesired outcomes. Several factors, such as placement techniques, EVT type selection, management during its use, EVT system exchanges, device removal, type of anesthesia, and how to avoid EVT-related adverse events are described in detail. Additionally, this review discusses good ways to promote effective communication with patients and relatives, surgeons, and multidisciplinary team. EVT possesses a unique mechanism of action including macro/micro deformation, changes in perfusion (stimulating angioneogenesis), exudate control, and bacterial clearance, promoting healing. EVT has an adequate safety profile and higher clinical success rate compared to any other endoscopic therapy for TGID. Additionally, pre-emptive EVT and its novel indications are promising due to its satisfactory effectiveness in initial studies. Therefore, detailing some practical solutions obtained by years of experience may collaborate to widespread EVT adoption, providing less-invasive treatment for several critical conditions to more patients worldwide.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Division, Instituto D’Or de Pesquisa e Ensino-Hospital Vila Nova Star, São Paulo, SP, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruno Salomão Hirsch
- Deparment of Gastroenteroloy, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Pedro Henrique Boraschi Vieira Ribas
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Saullo Queiroz Silveira
- Department of Anesthesiology-CMA Anesthesia Group, Instituto D’Or de Pesquisa e Ensino-Hospital Vila Nova Star, São Paulo, SP, Brazil
| | - Hugo Gonçalo Guedes
- Gastrointestinal Endoscopy Unit, Instituto D’Or de Pesquisa e Ensino-Hospital DF Star, Brasília, DF, Brazil
| | - Alexandre Moraes Bestetti
- Gastrointestinal Endoscopy Division, Instituto D’Or de Pesquisa e Ensino-Hospital Vila Nova Star, São Paulo, SP, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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3
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Matteo MV, Birligea MM, Bove V, Pontecorvi V, De Siena M, Gualtieri L, Barbaro F, Spada C, Boškoski I. Management of fistulas in the upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 2024; 70:101929. [PMID: 39053982 DOI: 10.1016/j.bpg.2024.101929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Abstract
Fistulas in the upper gastrointestinal (GI) tract are complex conditions associated with elevated morbidity and mortality. They may arise as a result of inflammatory or malignant processes or following medical procedures, including endoscopic and surgical interventions. The management of upper GI is often challenging and requires a multidisciplinary approach. Accurate diagnosis, including endoscopic and radiological evaluations, is crucial to build a proper and personalized therapeutic plan, that should take into account patient's clinical conditions, time of onset, size, and anatomical characteristics of the defect. In recent years, several endoscopic techniques have been introduced for the minimally invasive management of upper GI fistulas, including through-the-scope and over-the-scope clips, stents, endoscopic suturing, endoluminal vacuum therapy (EVT), tissue adhesives, endoscopic internal drainage. This review aims to discuss and detail the current available endoscopic techniques for the treatment of upper GI fistulas.
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Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
| | | | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Loredana Gualtieri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Sapienza University of Rome, 00161, Rome, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
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Pattynama LMD, Eshuis WJ, Seewald S, Pouw RE. Multi-modality management of defects in the gastrointestinal tract: Where the endoscope meets the scalpel: Endoscopic vacuum therapy in the upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 2024; 70:101901. [PMID: 39053979 DOI: 10.1016/j.bpg.2024.101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Transmural defects in the upper gastrointestinal (GI) tract, such as anastomotic leakage and oesophageal perforations, are associated with significant morbidity and mortality risks. Endoscopic vacuum therapy (EVT) is an efficient and safe treatment option for these patients. With the growing use of EVT in the upper GI tract, it is important to share expertise on the topic. AIM This review explores the emerging role of endoscopic vacuum therapy (EVT) as treatment for transmural defects in the upper GI tract. An overview of the mechanism and procedures, outcomes in current literature and challenges of implementation and application are discussed. CONCLUSION EVT exhibits great efficacy and safety for the treatment of transmural defects in the upper GI tract. Current use of EVT is mostly experience-based, emphasizing the importance of sharing expertise and performing research to unlock its full potential.
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Affiliation(s)
- Lisanne M D Pattynama
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Wietse J Eshuis
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Stefan Seewald
- Centre of Gastroenterology, Klinik Hirslanden, Zürich, Switzerland.
| | - Roos E Pouw
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Firkins SA, Simons-Linares R. Management of leakage and fistulas after bariatric surgery. Best Pract Res Clin Gastroenterol 2024; 70:101926. [PMID: 39053976 DOI: 10.1016/j.bpg.2024.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Stephen A Firkins
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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de Oliveira AT, Barreira MA, da Cunha Parente Júnior JW, Junior JRLH, Ribeiro JBES, de Azevedo OGR, de Vasconcelos PRC. Endoscopic self-expandable metal stent versus endoscopy vacuum therapy for traumatic esophageal perforations: a retrospective cohort study. Surg Endosc 2024; 38:2142-2147. [PMID: 38448621 PMCID: PMC10978687 DOI: 10.1007/s00464-024-10755-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Traumatic esophageal perforations (TEP) are a grave medical condition and require immediate intervention. Techniques such as Esophageal Self-Expandable Metal Stent (E-SEMS) and Endoscopic Vacuum Therapy (EVT) show promise in reducing tissue damage and controlling esophageal leakage. The present study aims to compare the application of EVT to E-SEMS placement in TEP. METHODS Retrospective cohort study valuated 30 patients with TEP. The E-SEMS and EVT groups were assessed for time of hospitalization, treatment duration, costs, and clinical outcome. RESULTS Patients treated with EVT (24.4 ± 13.2) demonstrated significantly shorter treatment duration (p < 0.005) compared to the group treated with E-SEMS (45.8 ± 12.9) and patients submitted to E-SEMS demonstrated a significant reduction (p = 0.02) in the time of hospitalization compared to the EVT (34 ± 2 vs 82 ± 5 days). Both groups demonstrated a satisfactory discharge rate (E-SEMS 93.7% vs EVT 71.4%) but did not show statistically significant difference (p = 0.3155). E-SEMS treatment had a lower mean cost than EVT (p < 0.05). Descriptive statistics were utilized, arranged in table form, where frequencies, percentages, mean, median, and standard deviation of the study variables were calculated and counted. The Fisher's Exact Test was used to evaluate the relationship between two categorical variables. To evaluate differences between means and central points, the parametric t-test was utilized. Comparisons with p value up to 0.05 were considered significant. CONCLUSION E-SEMS showed a shorter time of hospitalization, but a longer duration of treatment compared to EVT. The placement of E-SEMS and EVT had the same clinical outcome. Treatment with E-SEMS had a lower cost compared with EVT.
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Affiliation(s)
- Alessandrino Terceiro de Oliveira
- Department of Digestive Endoscopy, Dr. José Frota Institute, Fortaleza, CE, Brazil.
- Department of Surgery, Federal University of Ceara, Fortaleza, CE, Brazil.
- Department of Digestive Endoscopy, General Hospital of Fortaleza, Fortaleza, CE, Brazil.
- Department of Surgery, Federal University of Ceara, 1608 N. Prof Costa Mendes St, 3rd Floor, Fortaleza, CE, 60416-200, Brazil.
| | - Márcio Alencar Barreira
- Department of Surgery, Federal University of Ceara, Fortaleza, CE, Brazil
- Department of Surgery, Dr. José Frota Institute, Fortaleza, CE, Brazil
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Ciuntu BM, Tanevski A, Buescu DO, Lutenco V, Mihailov R, Ciuntu MS, Zuzu MM, Vintila D, Zabara M, Trofin A, Cadar R, Nastase A, Lupascu Ursulescu C, Lupascu CD. Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations. J Clin Med 2024; 13:470. [PMID: 38256604 PMCID: PMC10816729 DOI: 10.3390/jcm13020470] [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: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.
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Affiliation(s)
- Bogdan Mihnea Ciuntu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Adelina Tanevski
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - David Ovidiu Buescu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Valerii Lutenco
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Raul Mihailov
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Madalina Stefana Ciuntu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Mihai Marius Zuzu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Dan Vintila
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Mihai Zabara
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Trofin
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ramona Cadar
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Nastase
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Corina Lupascu Ursulescu
- Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cristian Dumitru Lupascu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Kouladouros K, Wichmann D, Loske G. The Role of Open-Pore Film Drainage Systems in Endoscopic Vacuum Therapy: Current Status and Review of the Literature. Visc Med 2024; 39:177-183. [PMID: 38205271 PMCID: PMC10775853 DOI: 10.1159/000535029] [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: 08/09/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024] Open
Abstract
Background Endoscopic vacuum therapy (EVT) is an increasingly popular endoscopic technique used for the treatment of wall defects in the gastrointestinal tract. Open-pore film drainage (OFD) systems are a new addition to the armamentarium of EVT and have shown encouraging results in a wide spectrum of applications. The aim of this review is to summarize the current literature on the applications of OFD systems in the gastrointestinal tract. Summary Open-pore film drainage (OFD) systems have been used for the treatment of several defects of the gastrointestinal tract. The small size and easy placement of these devices make them very useful, particularly for the treatment of defects that are small in size or difficult to reach. OFDs have been successfully used for both perforations and anastomotic leaks in various locations, with most reports focusing on the treatment of duodenal defects, although successful applications in the esophagus, stomach, and colon have also been reported. Lately, the role of OFDs in preemptive EVT has also been explored. Key Messages OFD systems are easy to use, particularly for small defects and challenging localizations. The current literature, consisting mainly of small case series and case reports, shows encouraging results, but further prospective studies are needed to explore and verify the indications and technical aspects of this innovative method.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy Department, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dörte Wichmann
- Interdisciplinary Endoscopy Unit, University Hospital Tübingen, Tübingen, Germany
| | - Gunnar Loske
- Department of General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Germany
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Gasanov MA, Danielyan SN, Chernousov FA, Gasanov AM, Rabadanov KM, Tatarinova EV, Barmina TG, Titova GP, Nevdah SK. [Endoscopic vacuum therapy in minimally invasive treatment of esophageal perforations]. Khirurgiia (Mosk) 2024:21-28. [PMID: 38258684 DOI: 10.17116/hirurgia202401121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. MATERIAL AND METHODS The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. RESULTS Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. CONCLUSION EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.
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Affiliation(s)
- M A Gasanov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - Sh N Danielyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- National Institute of Health, Yerevan, Armenia
| | - F A Chernousov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A M Gasanov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - K M Rabadanov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - E V Tatarinova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - T G Barmina
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - G P Titova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - S K Nevdah
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Estorninho J, Pimentel R, Gravito-Soares M, Gravito-Soares E, Amaro P, Figueiredo P. Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:444-450. [PMID: 38476151 PMCID: PMC10928871 DOI: 10.1159/000527317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/30/2022] [Indexed: 03/14/2024]
Abstract
Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.
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Affiliation(s)
- João Estorninho
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Pimentel
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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11
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Kiko I, Nehring D, Ma T. Creation of a Custom Endoluminal Vacuum-Assisted Device for Salvage of Ileal Pouch-Anal Anastomotic Leak. Cureus 2023; 15:e49754. [PMID: 38161943 PMCID: PMC10757675 DOI: 10.7759/cureus.49754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Endoluminal vacuum-assisted devices have become increasingly popular solutions for low-colorectal injuries and anastomotic defects in recent years. We present a case of a 23-year-old male who underwent salvage of an ileal pouch-anal anastomosis (IPAA) anastomotic leak with a customized endoluminal vacuum sponge and cavity marsupialization. This case highlights the easy-to-follow steps to create a customized endoluminal vacuum (endo-vac) sponge with readily available materials for the treatment of low colorectal anastomotic leaks. Included are step-by-step photos and instructions for successful endoluminal vacuum device construction.
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12
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Pattynama LMD, Pouw RE, Henegouwen MIVB, Daams F, Gisbertz SS, Bergman JJGHM, Eshuis WJ. Endoscopic vacuum therapy for anastomotic leakage after upper gastrointestinal surgery. Endoscopy 2023; 55:1019-1025. [PMID: 37253387 PMCID: PMC10602657 DOI: 10.1055/a-2102-1691] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Recently, endoscopic vacuum therapy (EVT) was introduced as treatment for anastomotic leakage after upper gastrointestinal (GI) surgery. The aim of this study was to describe the initial experience with EVT for anastomotic leakage after upper GI surgery in a tertiary referral center. METHODS Patients treated with EVT for anastomotic leakage after upper GI surgery were included retrospectively (January 2018-June 2021) and prospectively (June 2021-October 2021). The primary end point was the EVT success rate. Secondary end points included mortality and adverse events. RESULTS 38 patients were included (31 men; mean age 66 years): 27 had undergone an esophagectomy with gastric conduit reconstruction and 11 a total gastrectomy with esophagojejunal anastomosis. EVT was successful in 28 patients (74 %, 95 %CI 57 %-87 %). In 10 patients, EVT failed: deceased owing to radiation pneumonitis (n = 1), EVT-associated complications (n = 2), and defect closure not achieved (n = 7). Mean duration of successful EVT was 33 days, with a median of six EVT-related endoscopies. Median hospital stay was 45 days. CONCLUSION This initial experience with EVT for anastomotic leakage after upper GI surgery demonstrated a success rate of 74 %. EVT is a promising therapy that could prevent further major surgery. More experience with the technique and its indications will likely improve success rates in the future.
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Affiliation(s)
- Lisanne M. D. Pattynama
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Roos E. Pouw
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark I. van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jacques J. G. H. M. Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Wietse J. Eshuis
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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13
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de Moura DTH, Hirsch BS, McCarty TR, Lera Dos Santos ME, Guedes HG, Gomes GF, de Medeiros FS, de Moura EGH. Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects. Dig Endosc 2023; 35:745-756. [PMID: 36651679 DOI: 10.1111/den.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Endoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H-EVT) for the treatment of TGID. METHODS Retrospective multicenter study including patients who underwent H-EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure. RESULTS A total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H-EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33-1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H-EVT placement (HR 0.70; 95% CI 0.55-0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H-EVT (odds ratio 3.08; 95% CI 1.19-7.95) was a significant predictor of clinical success. Three device-related adverse events (2.08%) occurred. CONCLUSIONS The use of the H-EVT is feasible, safe, and effective for the management of TGID.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital São Luiz Morumbi, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Salomão Hirsch
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thomas R McCarty
- Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, USA
| | - Marcos Eduardo Lera Dos Santos
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital São Luiz Jabaquara, São Paulo, Brazil
| | - Hugo Gonçalo Guedes
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Santa Luzia, Brasilia, Brazil
| | | | | | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital São Luiz Morumbi, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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14
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Kollmann L, Reimer S, Lock JF, Flemming I, Widder A, May J, Krietenstein L, Gruber M, Meining A, Hankir M, Germer CT, Seyfried F. Endoscopic vacuum therapy as a first-line treatment option for gastric leaks after bariatric surgery: evidence from 10 years of experience. Surg Obes Relat Dis 2023; 19:1041-1048. [PMID: 36948972 DOI: 10.1016/j.soard.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/04/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Gastric (anastomotic or staple-line) leaks after bariatric surgery are rare but potentially life-threatening complications. Endoscopic vacuum therapy (EVT) has evolved as the most promising treatment strategy for leaks associated with upper gastrointestinal surgery. OBJECTIVE The aim of this study was to evaluate the efficiency of our gastric leak management protocol in all bariatric patients over a 10-year period. Special emphasis was placed on EVT treatment and its outcome as a primary treatment or as a secondary treatment when other approaches failed. SETTING This study was performed at a tertiary clinic and certified center of reference for bariatric surgery. METHODS In this retrospective single-center cohort study, clinical outcomes of all consecutive patients after bariatric surgery from 2012 to 2021 are reported, with special emphasis placed on gastric leak treatment. The primary endpoint was successful leak closure. Secondary endpoints were overall complications (Clavien-Dindo classification) and length of stay. RESULTS A total of 1046 patients underwent primary or revisional bariatric surgery, of whom 10 (1.0%) developed a postoperative gastric leak. Additionally, 7 patients were transferred for leak management after external bariatric surgery. Of these, 9 patients underwent primary and 8 patients underwent secondary EVT after futile surgical or endoscopic leak management. The efficacy of EVT was 100%, and there were no deaths. Complications did not differ between primary EVT and secondary treatment of leaks. Length of treatment was 17 days for primary EVT versus 61 days for secondary EVT (P = .015). CONCLUSIONS EVT for gastric leaks after bariatric surgery led to rapid source control with a 100% success rate both as primary and secondary treatment. Early detection and primary EVT shortened treatment time and length of stay. This study underlines the potential of EVT as a first-line treatment strategy for gastric leaks after bariatric surgery.
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Affiliation(s)
- Lars Kollmann
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stanislaus Reimer
- Department of Gastroenterology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ilona Flemming
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Anna Widder
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Jana May
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Laura Krietenstein
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maximilian Gruber
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alexander Meining
- Department of Gastroenterology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mohammed Hankir
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
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15
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Le KHN, Kim KY, Skinner MJ. Management of a gastric pouch staple-line leak and its adverse events with multimodal endoscopic techniques including endoscopic vacuum therapy. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:342-347. [PMID: 37719947 PMCID: PMC10500158 DOI: 10.1016/j.vgie.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Video 1Management of a gastric pouch staple-line leak and its adverse events with multimodal endoscopic techniques including endoscopic vacuum therapy.
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Affiliation(s)
| | - Ki-Yoon Kim
- Division of Gastroenterology/Hepatology and Therapeutic Endoscopy, Scripps Clinic, La Jolla, California
| | - Matthew J Skinner
- Division of Gastroenterology/Hepatology and Therapeutic Endoscopy, Scripps Clinic, La Jolla, California
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16
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Fuentes KMI, Seastedt KP, Kidane B, Servais EL. Advanced Endoscopy for Thoracic Surgeons. Thorac Surg Clin 2023; 33:251-263. [PMID: 37414481 DOI: 10.1016/j.thorsurg.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The thoracic surgeon, well versed in advanced endoscopy, has an array of therapeutic options for foregut pathologic conditions. Peroral endoscopic myotomy (POEM) offers a less-invasive means to treat achalasia, and the authors' preferred approach is described in this article. They also describe variations of POEM, such as G-POEM, Z-POEM, and D-POEM. In addition, endoscopic stenting, endoluminal vacuum therapy, endoscopic internal drainage, and endoscopic suturing/clipping are discussed and can be valuable tools for esophageal leaks and perforations. Endoscopic procedures are advancing rapidly, and thoracic surgeons must maintain at the forefront of these technologies.
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Affiliation(s)
- Kathleen M I Fuentes
- Department of General Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | - Kenneth P Seastedt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Biniam Kidane
- Department of Surgery, University of Manitoba, Room GE-611, 820 Sherbook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Elliot L Servais
- Division of Thoracic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
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17
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Ding X, Zhang C, Li X, Liu T, Ma Y, Yin M, Li C, Zhou G, Wu G. The three-tube method via precise interventional placement for esophagojejunal anastomotic fistula after gastrectomy: a single-center experience. World J Surg Oncol 2023; 21:236. [PMID: 37528403 PMCID: PMC10391983 DOI: 10.1186/s12957-023-03105-7] [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: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients. METHODS This is retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage catheter, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated. RESULTS Sixty-four patients were included in the study. Insertion of the transnasal abscess drainage catheter, decompression tube, and jejunal nutrition tube was successful on the first attempt in all patients, while 35 patients received transnasal abscess drainage, 13 received percutaneous abscess drainage, and 16 received transnasal drainage plus percutaneous abscess drainage. Immediately after placement of the tube, the mean volume of drainage was 180 mL (range, 10-850 mL); the amount steadily decreased from then on. The clinical success rate was 84.3% (54/64). Median time to fistula healing was 58 days (range, 7-357 days). CONCLUSIONS Transnasal insertion of transnasal abscess drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy.
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Affiliation(s)
- Xiaolong Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chenchen Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tao Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chunxia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Gang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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18
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Gjeorgjievski M, Bareket R, Bhurwal A, Abdelqader A, Shahid H, Sarkar A, Tyberg A, Kahaleh M. Endoscopic vacuum therapy: 2 methods of successful endosponge placement for treatment of anastomotic leak in the upper GI tract. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:257-259. [PMID: 37456215 PMCID: PMC10339126 DOI: 10.1016/j.vgie.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Video 1Presentation of 2 methods of successful endosponge placement for treatment of anastomotic leak in the upper GI tract.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Romy Bareket
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Abdelhai Abdelqader
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Haroon Shahid
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Avik Sarkar
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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19
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Monino L, Moreels TG. Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks: How to Deal with the Challenges (with Video). Life (Basel) 2023; 13:1412. [PMID: 37374194 DOI: 10.3390/life13061412] [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: 03/13/2023] [Revised: 05/19/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
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.
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Affiliation(s)
- Laurent Monino
- Department of Gastroenterology & Hepatology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Tom G Moreels
- Department of Gastroenterology & Hepatology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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20
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Kouladouros K. Applications of endoscopic vacuum therapy in the upper gastrointestinal tract. World J Gastrointest Endosc 2023; 15:420-433. [PMID: 37397978 PMCID: PMC10308278 DOI: 10.4253/wjge.v15.i6.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the treatment of anastomotic leaks after esophageal and gastric surgery, it was also implemented for a wide range of defects, including acute perforations, duodenal lesions, and postbariatric complications. Apart from the initially proposed handmade sponge inserted using the “piggyback” technique, further devices were used, such as the commercially available EsoSponge and VAC-Stent as well as open-pore film drainage. The reported pressure settings and intervals between the subsequent endoscopic procedures vary greatly, but all available evidence highlights the efficacy of EVT, with high success rates and low morbidity and mortality, so that in many centers it is considered to be a first-line treatment, especially for anastomotic leaks.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Surgical Clinic, Mannheim University Hospital, University of Heidelberg, Mannheim 68167, Baden-Wuerttemberg, Germany
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21
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Daza Castro EM, Fuentes CF, Córdoba Guzmán AC, Aponte D, Rocha JN, González C, Sabbagh LC. Multimodal Endoscopic Management of Esophageal Perforations as a Complication of Peroral Endoscopic Myotomy for a Zenker's Diverticulum. ACG Case Rep J 2023; 10:e01059. [PMID: 37312755 PMCID: PMC10259639 DOI: 10.14309/crj.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/24/2023] [Indexed: 06/15/2023] Open
Abstract
Zenker's diverticulum develops because of a weakness in Killian's triangle, leading to a mucosal and submucosal herniation. Its treatment has evolved from morbid surgical interventions to safer endoscopic techniques such as peroral endoscopic myotomy (Z-POEM). Despite being a safe technique, Z-POEM is not free of complications such as perforations, bleeding, pneumoperitoneum, and pneumothorax, for which new endoscopic techniques have been developed. We present the case of a 53-year-old man taken to a Z-POEM who postoperatively presented dehiscence of the mucosotomy and a mediastinal collection, managed with a vacuum-assisted endoscopic closure device.
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Affiliation(s)
| | - Carlos Fernando Fuentes
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
| | | | - Diego Aponte
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
- Department of Gastroenterology, Sanitas Foundation University, Reina Sofía Clinic, Colsanitas Clinic, Keralty Group, Bogotá, Colombia
| | - José Nicolás Rocha
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
| | - Carlos González
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
- Department of Gastroenterology, Sanitas Foundation University, Reina Sofía Clinic, Colsanitas Clinic, Keralty Group, Bogotá, Colombia
| | - Luis Carlos Sabbagh
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
- Department of Gastroenterology, Sanitas Foundation University, Reina Sofía Clinic, Colsanitas Clinic, Keralty Group, Bogotá, Colombia
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Sozutek A, Tas EY, Yener K, Ozcomert J. Endoluminal Vacuum Therapy (EVT) for the Treatment of Rectal Perforation Following Cleansing Enema Application. Cureus 2023; 15:e35939. [PMID: 36911591 PMCID: PMC9997685 DOI: 10.7759/cureus.35939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Traumatic rectal injuries (TRIs) are challenging for surgeons because of their high morbidity and mortality. Considering the well-known predisposing factors, enema-associated rectal perforation seems to be the most overlooked entity that leads to devastating rectal injuries. A 61-year-old man with a three-day history of painful swelling around his perirectal area after enema application was referred to the outpatient clinic. CT demonstrated the presence of a left posterolateral rectal abscess compatible with an extraperitoneal rectal injury. Sigmoidoscopy revealed the perforation started 2 cm above the dentate line with a diameter of 10 cm and a depth of 3 cm. Endoluminal vacuum therapy (EVT) and laparoscopic sigmoid loop colostomy was performed. The patient was discharged after removing the system on postoperative Day 10. On his follow-up, the perforation side was totally closed and pelvic abscess was completely resolved two weeks after his discharge. EVT appears to be a simple, safe, well-tolerated and cost-effective therapeutic procedure in the management of delayed extraperitoneal rectal perforations (ERPs) with large defects. To our knowledge, this is the first case that reveals the potency of EVT in the management of a delayed rectal perforation associated with an uncommon entity.
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Affiliation(s)
- Alper Sozutek
- Gastroenterological Surgery, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
| | - Ekin Y Tas
- Gastroenterological Surgery, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
| | - Kemal Yener
- Gastroenterological Surgery, Health Sciences University, Adana City Training and Research Hospital, Adana , TUR
| | - Julia Ozcomert
- Gastroenterological Surgery, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
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23
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de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World J Gastroenterol 2023; 29:1173-1193. [PMID: 36926665 PMCID: PMC10011956 DOI: 10.3748/wjg.v29.i7.1173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023] Open
Abstract
Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
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Affiliation(s)
- Victor Lira de Oliveira
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Alexandre Moraes Bestetti
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Roberto Paolo Trasolini
- Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 021115, United States
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
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24
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Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It. BIOLOGY 2023; 12:biology12020178. [PMID: 36829457 PMCID: PMC9952935 DOI: 10.3390/biology12020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
(1) Background: This study's goals were to investigate possible risk factors for clinically relevant postoperative pancreatic fistula (POPF) grade B/C according to the updated definitions of the International Study Group of Pancreatic Surgery and to analyze possible treatment strategies; (2) Methods: Between 2017 and 2021, 200 patients were analyzed regarding the development of POPF grade B/C with an emphasis on postoperative outcome and treatment strategies; (3) Results: POPF grade B/C was observed in 39 patients (19.5%). These patients were younger, mainly male, had fewer comorbidities and showed a higher body mass index. Also, they had lower CA-19 levels, a smaller tumor size and softer pancreatic parenchyma. They experienced a worse outcome without affecting the overall mortality rate (10% vs. 6%, p = 0.481), however, this lead to a prolonged postoperative stay (28 (32-36) d vs. 20 (15-28) d, p ≤ 0.001). The majority of patients with POPF grade B/C were able to receive conservative treatment, followed by drainage placement, endoscopic vacuum-assisted therapy (EVT) and surgery. Conservative treatment resulted in a shorter length of the postoperative stay (24 (22-28) d vs. 34 (26-43) d, p = 0.012); (4) Conclusions: Patients developing POPF grade B/C had a worse outcome; however, this did not affect the overall mortality rate. The majority of the patients were able to receive conservative treatment, resulting in a shorter length of their hospital stay.
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25
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The VACStent trial: combined treatment of esophageal leaks by covered stent and endoscopic vacuum therapy. Surg Endosc 2023; 37:3657-3668. [PMID: 36639580 PMCID: PMC10156910 DOI: 10.1007/s00464-023-09861-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Endoscopic treatment of esophageal leaks, mostly by covered stents or endoscopic vacuum therapy (EVT), has largely improved the clinical outcome in the last decade. However, both techniques suffer from significant limitations. Covered stents are hampered by a high rate of migration and missing functional drainage, whereas endoluminal EVT devices are limited by obstruction of the GI tract. The new design of the VACStent makes it a fully covered stent within a polyurethane sponge cylinder, allowing EVT while stent passage is still open. Initial clinical applications have demonstrated the fundamental concept of the VACStent. METHOD A prospective multicenter open-label study was performed with the primary endpoint safe practicality, complete leak coverage, and effective suction-treatment of esophageal leaks. Secondary endpoints were prevention of septic conditions, successful leak healing, and complications, in particular stent-migration, local erosions and bleeding. RESULTS Fifteen patients with different, mostly postoperative anastomotic leaks were enrolled in three centers. A total of 41 VACStents were implanted. The mean number of VACStents per patient was 2.7, with a mean duration of VACStent treatment of 15 days. The primary endpoint was met in all VACStent applications (41/41 implants), resulting in a leak healing rate of 80% (12/15 patients). Septic episodes were prevented in 93% (14/15 patients) and there was no mortality. There were no severe device-related adverse events (SADE) nor significant local bleeding or erosion. Minor stent-dislocation and migration, respectively, was observed in 7%. Oral intake of liquids or food was documented in 87% (13/15 patients). One anastomotic stenosis was seen during follow-up. CONCLUSIONS VACStent treatment is a safe and effective treatment in esophageal leaks which can be covered by the sponge cylinder. Its application was described as easy and resembling that of conventional GI stents, with an impressive clinical success rate comparable to EVT outcomes. The VACStent offers a new option for clinical treatment of critical situations in esophageal perforations and anastomotic sutureline failures.
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26
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Wichmann D, Stüker D, Schweizer U, Senne M, Duckworth-Mothes B, Zerabruck E, Königsrainer A, Bachmann J. Endoscopic negative pressure therapy for duodenal leaks. Front Surg 2023; 10:1099457. [PMID: 37143771 PMCID: PMC10151564 DOI: 10.3389/fsurg.2023.1099457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Background and study aim Endoscopic negative pressure therapy (ENPT) is well established in the treatment of perforations of various etiologies in the upper and lower gastrointestinal tract. For duodenal perforations exist only case reports and series. Different indications are possible for ENPT in duodenal position: primary therapy for leaks, preemptive therapy after surgery for example, after ulcer suturing or resection with anastomoses, or as second line therapy in cases of recurrent anastomotic insufficiencies with leakage of duodenal secretion. Methods A retrospective 4-year case series of negative pressure therapy in duodenal position indicated by different etiologies and a comprehensive review of current literature on endoscopic negative pressure duodenal therapy are presented. Results Patients with primary duodenal leaks n= 6 and with duodenal stump insufficiencies n = 4 were included. In seven patients ENPT was the first line and sole therapy. Primary surgery for duodenal leak was performed in n = 3 patients. Mean duration of ENPT was 11.0 days, mean hospital stay was 30.0 days. Re-operation after start of ENPT was necessary in two patients with duodenal stump insufficiencies. Surgery after termination of the ENPT was not necessary in any patient. Discussion In our case series and in the literature, ENPT has been shown to be very successful in the therapy of duodenal leaks. A challenge in ENPT for duodenal leaks is the appropriate length of the probe to safely reach the leak and keep the open pore element at the end of the probe in place despite intestinal motility.
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Affiliation(s)
- Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
- Interdisciplinary Endoscopic Unit at the University Hospital of Tübingen, Tübingen, Germany
- Working Group of Experimental Endoscopy, Development and Training of the Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
- Correspondence: Dörte Wichmann
| | - Dietmar Stüker
- Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
- Interdisciplinary Endoscopic Unit at the University Hospital of Tübingen, Tübingen, Germany
| | - Ulrich Schweizer
- Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
- Interdisciplinary Endoscopic Unit at the University Hospital of Tübingen, Tübingen, Germany
- Working Group of Experimental Endoscopy, Development and Training of the Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
| | - Moritz Senne
- Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
| | - Benedikt Duckworth-Mothes
- Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
- Working Group of Experimental Endoscopy, Development and Training of the Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
| | - Emanuel Zerabruck
- Interdisciplinary Endoscopic Unit at the University Hospital of Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, Tübingen, Germany
| | - Jeannine Bachmann
- Clinic and Outpatient Department for Surgery, University Hospital Right of the Isar, Munich, Germany
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27
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Pattynama LM, Eshuis WJ, Wielenga MC, Pouw RE. Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using vacuum sponge and vacuum stent. VideoGIE 2023; 8:144-147. [PMID: 37095835 PMCID: PMC10122104 DOI: 10.1016/j.vgie.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Video 1Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using EsoSponge and VACStent.
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28
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Endoscopic Closure: Tools and Techniques. Gastrointest Endosc Clin N Am 2023; 33:169-182. [PMID: 36375881 DOI: 10.1016/j.giec.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The rapid expansion of third space endoscopy has necessitated development of innovative endoscopic defect closure devices and techniques. This article discusses commonly used endoscopic closure devices and techniques, data on their safety and efficacy, and a description of the authors' own practice patterns.
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29
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Pattynama LMD, Eshuis WJ, van Berge Henegouwen MI, Bergman JJGHM, Pouw RE. Vacuum-stent: A combination of endoscopic vacuum therapy and an intraluminal stent for treatment of esophageal transmural defects. Front Surg 2023; 10:1145984. [PMID: 36923375 PMCID: PMC10010284 DOI: 10.3389/fsurg.2023.1145984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Endoscopic vacuum therapy (EVT) has gained a greater role in management of transmural defects in the upper gastrointestinal (GI) tract, including anastomotic leakage and esophageal perforation (e.g. Boerhaave syndrome and iatrogenic causes). The vacuum-stent is a new treatment modality, combining the benefits of EVT and an intraluminal stent. Patients and methods This prospective case series describes the first ten cases of a transmural defect in the upper GI tract treated with a vacuum-stent in a tertiary referral center. All patients signed informed consent for prospective registration of relevant data on treatment and outcomes in a specially designed database. Outcome parameters were successful closure of the defect, number of endoscopies, duration of treatment and adverse events. Results In total, ten patients treated with a vacuum-stent were included. Eight patients had anastomotic leakage after esophageal resection, of whom six were treated with vacuum-sponge and vacuum-stent, and two with vacuum-stent only. One patient had Boerhaave syndrome, treated with vacuum-sponge and vacuum-stent, and one had an iatrogenic perforation during pneumodilation for achalasia, treated with vacuum-stent only. Success rate was 100%, requiring a median of 5 (IQR 3-12) EVT-related endoscopies with a treatment course of median 18 (IQR 12-59) days. One patient developed an esophageal stricture, but no other vacuum-stent related adverse events were observed. Conclusion The vacuum-stent, which combines benefits of EVT and an intraluminal stent, shows great feasibility and efficacy in treatment of transmural defects in the upper GI tract. Future studies should point out whether this device can prevent major (re-)surgery in these patients.
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Affiliation(s)
- Lisanne M D Pattynama
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Roos E Pouw
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.,Department of Gastroenterology and Hepatology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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30
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Muacevic A, Adler JR, de Souza TF, Galvão Neto MDP, Grecco E, Waisberg J. Gastric Emptying and Its Correlation With Weight Loss and Body Mass Index in Patients With an Intragastric Balloon: A Prospective Study With Six Years of Follow-Up. Cureus 2022; 14:e32599. [PMID: 36654650 PMCID: PMC9840869 DOI: 10.7759/cureus.32599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity is the most well-established and prolonged pandemic in modern society. Having a better understanding of the available tools is important to improve weight loss and make the strategies more productive. This study aims to evaluate the effect of intragastric balloon (IGB) on gastric emptying time, its relationship with weight loss after IGB removal, and weight maintenance after six years. Methodology This prospective study analyzed data from patients undergoing IGB placement. A six-years follow-up was performed and data about weight maintenance were collected. We analyzed the impact of the IGB on gastrointestinal motility and its correlation with weight loss. Results Of the 20 patients included in the study, 52.4% were diagnosed with class I obesity and 47.6% with class II obesity. The mean weight of the patients was 96.5 ± 11.9 kg at baseline, 79.6 ± 11.4 kg at the time of IGB removal, 81.8 ± 9.1 kg at six months, and 93.2 ± 14.3 kg six years after IGB removal. The mean difference between the initial weight and that measured immediately after IGB removal was 16.68 ± 5.71 kg. Regarding gastric emptying time, there was a difference in retention on comparing the measurement before balloon placement to that after the balloon was in place (72.9% vs. 86.8%) after one hour of food intake. Comparing two hours after food intake, patients before IGB placement had a 30.6% food retention, while patients with IGB in place had a 69.2% retention. Conclusions In patients with class I or II obesity, the use of an IGB delayed gastric emptying of foods but showed no direct correlation with weight loss. Weight loss achieved after IGB placement was maintained in half of the patients at a six-year follow-up.
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31
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Ribeiro Jordão Sasso JG, Yvamoto EY, Rocha RSDP, Ribeiro IB, Boghossian MB, de Moura DTH, de Moura EGH. Modified endoscopic vacuum therapy for hypopharyngeal acute leakage after foreign body perforation. Endoscopy 2022; 54:E1022-E1023. [PMID: 36002012 PMCID: PMC9736810 DOI: 10.1055/a-1901-0829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Erika Yuki Yvamoto
- Gastrointestinal Endoscopy Service, University of São Paulo Faculty of Medicine Clinics Hospital (HCFMUSP), Sao Paulo, Brazil
| | - Rodrigo Silva de Paula Rocha
- Gastrointestinal Endoscopy Service, University of São Paulo Faculty of Medicine Clinics Hospital (HCFMUSP), Sao Paulo, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Service, University of São Paulo Faculty of Medicine Clinics Hospital (HCFMUSP), Sao Paulo, Brazil
| | - Mateus Bond Boghossian
- Gastrointestinal Endoscopy Service, University of São Paulo Faculty of Medicine Clinics Hospital (HCFMUSP), Sao Paulo, Brazil
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32
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Seika P, Biebl M, Raakow J, Berndt N, Feldbrügge L, Maurer MM, Dobrindt E, Thuss-Patience P, Pratschke J, Denecke C. The Association between Neoadjuvant Radio-Chemotherapy and Prolonged Healing of Anastomotic Leakage after Esophageal Resection Treated with EndoVAC Therapy. J Clin Med 2022; 11:jcm11164773. [PMID: 36013012 PMCID: PMC9410280 DOI: 10.3390/jcm11164773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Endoscopic vacuum therapy (EVT) has become the mainstay in the treatment of early anastomotic leakage (AL) after esophageal resection. The effect of nRCT on the efficacy of EVT is currently unknown. (2) Methods: Data of 427 consecutive patients undergoing minimally invasive esophagectomy between 2013 and 2022 were analyzed. A total of 26 patients received EVT for AL after esophagectomy between 2010 and 2021. We compared a cohort of 13 patients after treatment with EVT for anastomotic leakage after neoadjuvant radiochemotherapy (nRCT) with a control group of 13 patients after neoadjuvant chemotherapy (nCT) using inverse propensity score weighting to adjust for baseline characteristics between the groups. EVT therapy was assessed regarding patient survival, treatment failure as defined by a change in treatment to stent/operation, duration of treatment, and secondary complications. Statistical analysis was performed using linear regression analysis. (3) Results: Time to EVT after initial tumor resection did not vary between the groups. The duration of EVT was longer in patients after nRCT (14.69 days vs. 20.85 days, p = 0.002) with significantly more interventions (4.38 vs. 6.85, p = 0.001). The success rate of EVT did not differ between the two groups (nCT n = 8 (61.54%) vs. nCT n = 5 (38.46%), p = 0.628). The rate of operative revision did not vary between the groups. Importantly, no mortality was reported within 30 days and 90 days in both groups. (4) Conclusions: EVT is a valuable tool for the management of AL after esophageal resection in patients after nRCT. While the success rates were comparable, EVT was associated with a significantly longer treatment duration. Anastomotic leakages after nRCT often require prolonged and multimodal treatment strategies while innovative strategies such as prophylactic endoVAC placement or use of a VAC-Stent may be considered.
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Affiliation(s)
- Philippa Seika
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Matthias Biebl
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Jonas Raakow
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Nadja Berndt
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Linda Feldbrügge
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Max Magnus Maurer
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Eva Dobrindt
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Peter Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Johann Pratschke
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Christian Denecke
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
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33
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Intriago JMV, de Moura DTH, do Monte Junior ES, Proença IM, Ribeiro IB, Sánchez-Luna SA, Bernardo WM, de Moura EGH. Endoscopic Vacuum Therapy (EVT) for the Treatment of Post-Bariatric Surgery Leaks and Fistulas: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3435-3451. [PMID: 35918596 DOI: 10.1007/s11695-022-06228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Bariatric surgery remains the most effective treatment for morbid obesity and its comorbidities. However, post-surgical leaks and fistulas can occur in about 1-5% of patients, with challenging treatment approaches. Endoscopic vacuum therapy (EVT) has emerged as a promising tool due to its satisfactory results and accessibility. In this first systematic review and meta-analysis on the subject, EVT revealed rates of 87.2% clinical success, 6% moderate adverse events, and 12.5% system dislodgements, requiring 6.47 EVT system exchanges every 4.39 days, with a dwell time of 25.67 days and a total length of hospitalization of 44.43 days. Although our results show that EVT is a safe and effective therapy for post-surgical leaks and fistulas, they should be interpreted with caution due to the paucity of available data.
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Affiliation(s)
- Josselyn Mariana Vera Intriago
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Epifanio Silvino do Monte Junior
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Igor Mendonça Proença
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Igor Braga Ribeiro
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil.
| | - Sergio A Sánchez-Luna
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Wanderley Marques Bernardo
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
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de Moura DTH, Hirsch BS, Boghossian MB, de Medeiros FS, McCarty TR, Thompson CC, de Moura EGH. Low-cost modified endoscopic vacuum therapy using a triple-lumen tube allows nutrition and drainage for treatment of an early post-bariatric surgery leak. Endoscopy 2022; 54:E376-E377. [PMID: 34374043 DOI: 10.1055/a-1540-5870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Salomão Hirsch
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mateus Bond Boghossian
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Thomas R McCarty
- Gastroenterology, Hepatology and Endoscopy Division - Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Gastroenterology, Hepatology and Endoscopy Division - Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Endoscopic vacuum therapy for post-esophagectomy anastomotic dehiscence as rescue treatment: a single center case series. Esophagus 2022; 19:417-425. [PMID: 35347509 DOI: 10.1007/s10388-022-00912-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/18/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic vacuum therapy (EVT) represents an effective endoscopic technique for the treatment of post-esophagectomy leaks and can be used after failure of primary treatment. We aimed to investigate endoscopic data and success rate of EVT for post-esophagectomy anastomotic leaks, after failed redo surgery or previous endoscopic treatment. METHODS We retrospectively recruited 12 patients from January 2018 to October 2020. Success was defined as dehiscence closure at radiological and/or endoscopic evaluation. Ethical Committee of our institution approved the study. RESULTS Twelve patients (66.7% male, mean age 65.08 ± 16.7 years) affected by esophago-gastric (n = 10) or esophago-jejunal (n = 2) anastomosis dehiscences after oncologic surgery were treated with EVT, after failure of previous redo-surgical (n = 3, 25%) or endoscopic management (n = 9, 75%). Technical success rate was 100% (60/60 procedures) and dehiscence closure was achieved in three quarters of patients (9/12, 75%). Regarding complications, one case of sponge dislocation (1/60 = 1.7%) and another case of delayed stricture after post-EVT stent placement (1/60 = 1.7%) were recorded, during a mean follow up of 182.3 days. CONCLUSIONS EVT is a promising option in the treatment of the most complicated anastomotic dehiscences. Its use could be also considered after failure of previous endoscopic or surgical management.
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Sánchez-Luna SA, Thompson CC, De Moura EGH, de Medeiros FS, De Moura DTH. Modified endoscopic vacuum therapy: Are we ready for prime time? Gastrointest Endosc 2022; 95:1281-1282. [PMID: 35589208 DOI: 10.1016/j.gie.2021.12.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/31/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Sergio A Sánchez-Luna
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Diogo Turiani Hourneaux De Moura
- Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Lee TG, Kim DH, Yun H, Ryu DH. Successful endoscopic vacuum therapy for the lateral duodenal fistula. Asian J Surg 2022; 45:1807-1808. [PMID: 35599128 DOI: 10.1016/j.asjsur.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Taek-Gu Lee
- Department of Surgery, Chungbuk National University Hospital, South Korea; Department of Surgery, Chungbuk National University College of Medicine, South Korea
| | - Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, South Korea; Department of Surgery, Chungbuk National University College of Medicine, South Korea.
| | - HyoYung Yun
- Department of Surgery, Chungbuk National University Hospital, South Korea; Department of Surgery, Chungbuk National University College of Medicine, South Korea
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University Hospital, South Korea; Department of Surgery, Chungbuk National University College of Medicine, South Korea
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Reimer S, Lock JF, Flemming S, Weich A, Widder A, Plaßmeier L, Döring A, Hering I, Hankir MK, Meining A, Germer CT, Groneberg K, Seyfried F. Endoscopic Management of Large Leakages After Upper Gastrointestinal Surgery. Front Surg 2022; 9:885244. [PMID: 35615653 PMCID: PMC9124894 DOI: 10.3389/fsurg.2022.885244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Endoscopic vacuum therapy (EVT) is an evidence-based option to treat anastomotic leakages of the upper gastrointestinal (GI) tract, but the technical challenges and clinical outcomes of patients with large defects remain poorly described. Methods All patients with leakages of the upper GI tract that were treated with endoscopic negative pressure therapy at our institution from 2012-2021 were analyzed. Patients with large defects (>30 mm) as an indicator of complex treatment were compared to patients with smaller defects (control group). Results Ninety-two patients with postoperative anastomotic or staplerline leakages were identified, of whom 20 (21.7%) had large defects. Compared to the control group, these patients required prolonged therapy (42 vs. 14 days, p < 0.001) and hospital stay (63 vs. 26 days, p < 0.001) and developed significantly more septic complications (40 vs. 17.6%, p = 0.027.) which often necessitated additional endoscopic and/or surgical/interventional treatments (45 vs. 17.4%, p = 0.007.) Nevertheless, a resolution of leakages was achieved in 80% of patients with large defects, which was similar compared to the control group (p = 0.42). Multiple leakages, especially on the opposite side, along with other local unfavorable conditions, such as foreign material mass, limited access to the defect or extensive necrosis occurred significantly more often in cases with large defects (p < 0.001). Conclusions Overall, our study confirms that EVT for leakages even from large defects of the upper GI tract is feasible in most cases but comes with significant technical challenges.
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Affiliation(s)
- Stanislaus Reimer
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Johan F. Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander Weich
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Anna Widder
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Lars Plaßmeier
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Anna Döring
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ilona Hering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Mohammed K. Hankir
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander Meining
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Kaja Groneberg
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
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McCarty TR, Kumar N. Revision Bariatric Procedures and Management of Complications from Bariatric Surgery. Dig Dis Sci 2022; 67:1688-1701. [PMID: 35347535 DOI: 10.1007/s10620-022-07397-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
Abstract
Bariatric surgery is effective, but may be associated with adverse events. A multi-disciplinary approach including endoscopic interventions can be effective to manage these. Endoscopists should familiarize themselves with gastrointestinal pathology which can occur after bariatric surgery, including nutritional deficiencies, acid reflux, anastomotic stenosis, gallstone disease, leaks, fistulas, and weight regain. Endoscopic interventions including anastomotic stricture dilation, control of bleeding, endoscopic ultrasound-guided approach for endoscopic retrograde cholangiopancreatography, leak or fistula closure via endoscopic suturing or stent placement, and transoral outlet reduction (TORe) or revision obesity surgery endoluminal (ROSE) to address weight regain are among the endoscopic tools which have demonstrated safety and efficacy in the management of adverse events after bariatric surgery.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Nitin Kumar
- HSHS Medical Group, Springfield, IL, 62704, USA.
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Gutschow CA, Schlag C, Vetter D. Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it. Langenbecks Arch Surg 2022; 407:957-964. [PMID: 35041047 PMCID: PMC9151563 DOI: 10.1007/s00423-022-02436-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic vacuum therapy (EVT) has emerged as a novel treatment option for upper gastrointestinal wall defects. The basic principle of action of EVT entails evacuation of secretions, removal of wound debris, and containment of the defect. Furthermore, there is increasing evidence that EVT reduces interstitial edema, increases oxygen saturation, and promotes tissue granulation and microcirculation. Various devices, such as macroporous polyurethane sponge systems or open-pore film drains, have been developed for specific indications. Depending on the individual situation, EVT devices can be placed in- or outside the intestinal lumen, as a stand-alone procedure, or in combination with surgical, radiological, and other endoscopic interventions. PURPOSE The aim of this narrative review is to describe the current spectrum of EVT in the upper gastrointestinal tract and to assess and summarize the related scientific literature. CONCLUSIONS There is growing evidence that the efficacy of EVT for upper GI leakages exceeds that of other interventional treatment modalities such as self-expanding metal stents, clips, or simple drainages. Owing to the promising results and the excellent risk profile, EVT has become the therapy of choice for perforations and anastomotic leakages of the upper gastrointestinal tract in many centers of expertise. In addition, recent clinical research suggests that preemptive use of EVT after high-risk upper gastrointestinal resections may play an important role in reducing postoperative morbidity.
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Affiliation(s)
- Christian A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Diana Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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de Moura DTH, Dantas ACB, Ribeiro IB, McCarty TR, Takeda FR, Santo MA, Nahas SC, de Moura EGH. Status of bariatric endoscopy–what does the surgeon need to know? A review. World J Gastrointest Surg 2022; 14:185-199. [PMID: 35317547 PMCID: PMC8908340 DOI: 10.4240/wjgs.v14.i2.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/14/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options available. Currently, there are several multidisciplinary therapeutic options for its management, including conservative, endoscopic, and surgical treatment.
AIM To clarify indications, technical aspects, and outcomes of bariatric endoscopy.
METHODS Narrative review of current literature based on electronic databases including MEDLINE (PubMed), Cochrane Library, and SciELO.
RESULTS Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical complications. Various devices act upon different mechanisms of action, which may be individualized to each patient. Despite favorable results for the endoscopic treatment of obesity, prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic therapies. Regarding the management of bariatric surgery complications, endoscopic therapy may be considered the procedure of choice in a variety of situations. Still, as there is no standardized algorithm, local experience should be considered in decision-making.
CONCLUSION The treatment of patients with obesity is complex, and a multidisciplinary approach is essential. Bariatric endoscopy has shown impressive results both in the treatment of obesity and its surgical complications, and therefore, must be part of the armamentarium in the fight against this disease.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - Anna Carolina Batista Dantas
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Igor Braga Ribeiro
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA 021115, United States
| | - Flávio Roberto Takeda
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Marco Aurelio Santo
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Sergio Carlos Nahas
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
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Chan SM, Auyeung KKY, Lam SF, Chiu PWY, Teoh AYB. Current status in endoscopic management of upper gastrointestinal perforations, leaks and fistulas. Dig Endosc 2022; 34:43-62. [PMID: 34115407 DOI: 10.1111/den.14061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
Recent advancement in endoscopic closure techniques have revolutionized the treatment of gastrointestinal perforations, leaks and fistulas. Traditionally, these have been managed surgically. The treatment strategy depends on the size and location of the defect, degree of contamination, presence of healthy surrounding tissues, patients' condition and the availability of expertise. One of the basic principles of management includes providing a barricade to the flow of luminal contents across the defect. This can be achieved with a wide range of endoscopic techniques. These include endoclips, stenting, suturing, tissue adhesives and glue, and endoscopic vacuum therapy. Each method has their distinct indications and shortcomings. Often, a combination of these techniques is required. Apart from endoscopic closure, drainage procedures by the interventional radiologist and surgical management also play an important role. In this review article, the outcomes of each of these endoscopic closure techniques in the literature is provided in tables, and practical management algorithms are being proposed.
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Affiliation(s)
- Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kitty Kit Ying Auyeung
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Siu Fung Lam
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Philip Wai Yan Chiu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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OUP accepted manuscript. Br J Surg 2022; 109:812-821. [DOI: 10.1093/bjs/znac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/07/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022]
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Tuñon C, De Lucas J, Cubilla J, Andrade R, Aguirre M, Zúñiga Cisneros J. Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis. BMC Gastroenterol 2021; 21:484. [PMID: 34930127 PMCID: PMC8685809 DOI: 10.1186/s12876-021-02058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. CASE PRESENTATION We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. CONCLUSION Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.
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Affiliation(s)
- Carlos Tuñon
- Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama
| | - Juan De Lucas
- Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama
| | - Jan Cubilla
- Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama
| | - Rafael Andrade
- Department of Thoracic Surgery, Santo Tomas Hospital, Panama City, Panama
| | - Miguel Aguirre
- Department of Thoracic Surgery, Santo Tomas Hospital, Panama City, Panama
| | - Julio Zúñiga Cisneros
- Department of Internal Medicine, Santo Tomas Hospital, Bella Vista, Panama City, Panama.
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de Moura DTH, Hirsch BS, Do Monte Junior ES, McCarty TR, de Medeiros FS, Thompson CC, de Moura EGH. Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages. VideoGIE 2021; 6:523-528. [PMID: 34917860 PMCID: PMC8645785 DOI: 10.1016/j.vgie.2021.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Salomão Hirsch
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Epifânio Silvino Do Monte Junior
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Christopher C Thompson
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Wichmann D, Jansen KT, Onken F, Stüker D, Zerabruck E, Werner CR, Yurttas C, Thiel K, Königsrainer A, Quante M. Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases. BMC Gastroenterol 2021; 21:436. [PMID: 34802417 PMCID: PMC8607673 DOI: 10.1186/s12876-021-02018-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Endoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula. Case presentation We present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days. Conclusions This is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-02018-7.
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Affiliation(s)
- Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Kai Tobias Jansen
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Flurina Onken
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Dietmar Stüker
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Emanuel Zerabruck
- Interdisciplinary Endoscopic Unit, University Hospital of Tübingen, Hoppe-Seyler-Str. 6, 72076, Tübingen, Germany
| | - Christoph R Werner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Gastrointestinal Oncology, Infectiology and Geriatrics, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Markus Quante
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Livingstone I, Pollock L, Sgromo B, Mastoridis S. Current Status of Endoscopic Vacuum Therapy in the Management of Esophageal Perforations and Post-Operative Leaks. Clin Endosc 2021; 54:787-797. [PMID: 34781418 PMCID: PMC8652150 DOI: 10.5946/ce.2021.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022] Open
Abstract
Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and pose a significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopic vacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of a polyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention of promoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasingly adopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growing body of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupled with the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has become increasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications, technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight future directions for the use of EVT in esophageal wall defects.
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Affiliation(s)
| | | | - Bruno Sgromo
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sotiris Mastoridis
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Grund KE, Schweizer U, Zipfel A, Duckworth-Mothes B. Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT). Chirurg 2021; 93:56-63. [PMID: 34570261 DOI: 10.1007/s00104-021-01497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative. PROBLEM The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. METHODS Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT. RESULTS In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. DISCUSSION Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.
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Affiliation(s)
- K E Grund
- Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.
| | - U Schweizer
- Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany
| | - A Zipfel
- Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany
| | - B Duckworth-Mothes
- Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.,Surgical Endoscopy, Experimental Endoscopy, Research and Training, Centre for Medical Research, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany
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50
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do Monte Junior ES, de Moura DTH, Ribeiro IB, Hathorn KE, Farias GFA, Turiani CV, Medeiros FS, Bernardo WM, de Moura EGH. Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta-analysis. Dig Endosc 2021; 33:892-902. [PMID: 33300634 DOI: 10.1111/den.13813] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. OBJECTIVES The aim of this study is to perform a systematic review and meta-analysis to investigate the efficacy and safety of self-expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. METHODS Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. RESULTS Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10-0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03-0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38-20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13-0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. CONCLUSION Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.
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Affiliation(s)
- Epifanio Silvino do Monte Junior
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Sao Paulo, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Sao Paulo, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Sao Paulo, Brazil
| | - Kelly Elizabeth Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy - Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Galileu Ferreira Ayala Farias
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Sao Paulo, Brazil
| | | | | | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Sao Paulo, Brazil
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