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Le TM, Tran VH, Chung KS, Jeon SW. Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review. Clin Endosc 2025; 58:181-190. [PMID: 39511930 PMCID: PMC11983136 DOI: 10.5946/ce.2024.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/30/2024] [Accepted: 08/14/2024] [Indexed: 11/15/2024] Open
Abstract
Endoscopic vacuum therapy (EVT) has emerged as a transformative approach for managing gastrointestinal (GI) transmural defects, offering a less invasive and more promising alternative to surgery. Initially developed to address anastomotic leaks after rectal surgery, the application of EVT has expanded to include other locations within the GI tract. This review investigated the principles, indications, procedures, outcomes, challenges, and future perspectives of EVT for the management of GI transmural defects. In conclusion, EVT has demonstrated favorable outcomes in GI defect closure, with reduced complications, shortened hospital stay, and decreased morbidity rates as compared with conventional treatments. Although EVT faces challenges in some specific anatomical locations and in managing severe complications such as major bleeding, ongoing advancements in technology and standardization efforts offer promise for broader indications and better outcomes. Future perspectives include exploring novel EVT devices, refining patient selection criteria and pre-emptive applications, and standardizing procedural protocols.
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Affiliation(s)
- Tan Minh Le
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Korea
- BK21 Four Program, Kyungpook National University School of Medicine, Daegu, Korea
| | - Van Huy Tran
- Gastroenterology and Endoscopy Center, University of Medicine and Pharmacy Hospital, Hue University, Hue, Viet Nam
| | - Kyu Sung Chung
- Gastroenterology and Endoscopy Center, University of Medicine and Pharmacy Hospital, Hue University, Hue, Viet Nam
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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2
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Adamenko O, Ferrari C, Seewald S, Schmidt J. Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review. Updates Surg 2022; 74:1177-1186. [PMID: 35262844 DOI: 10.1007/s13304-022-01265-x] [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: 01/14/2022] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
In the last decade, endoluminal vacuum therapy (eVAC) has emerged as an effective treatment for anastomotic leak (AL); however, little is known regarding its prophylactic use. In this systematic review we evaluated overall outcomes in patients undergoing major gastrointestinal surgery and treated with prophylactic eVAC. A systematic review of English articles on four electronic databases was performed according to the PRISMA statement up until January 2022. References of selected articles were manually screened to identify relevant missing papers. Primary endpoints were AL and mortality rates estimates. Secondary endpoints included analysis of eVAC-associated morbidity, treatment duration, long-term complications, and general indications for the eVAC management in the perioperative period. A total of 11 studies (5 case reports, 5 retrospective case series and a retrospective, case-control study) were included in the analysis. AL ranged from 0 to 25%. No major eVAC-associated complications were observed, except for sponge dislocation or obstruction. Overall mortality ranged between 0 and 12.5%; however, these fatalities were neither related to the use of eVAC, nor to AL-associated complications. The most frequent long-term complication was anastomotic stenosis responsive to endoscopic dilatation in most cases. The operating negative pressure ranged from -25 to -125 mmHg among different papers. In all studies but two, prophylactic eVAC was applied to anastomoses at high risk of dehiscence based on the subjective evaluation of the leading surgeon. In conclusion, prophylactic eVAC is safe and it could lead to potential benefit for prevention of AL, especially in high-risk anastomoses.
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Affiliation(s)
| | - Carlo Ferrari
- Hirslanden Hospitals, Zürich, Switzerland. .,Università degli Studi di Milano, Milano, Italy.
| | - Stefan Seewald
- Hirslanden Hospitals, Zürich, Switzerland.,GastroZentrum Hirslanden, Zürich, Switzerland
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Cereatti F, Grassia R, Drago A, Conti CB, Donatelli G. Endoscopic management of gastrointestinal leaks and fistulae: What option do we have? World J Gastroenterol 2020; 26:4198-4217. [PMID: 32848329 PMCID: PMC7422542 DOI: 10.3748/wjg.v26.i29.4198] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/10/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal leaks and fistulae are serious, potentially life threatening conditions that may occur with a wide variety of clinical presentations. Leaks are mostly related to post-operative anastomotic defects and are responsible for an important share of surgical morbidity and mortality. Chronic leaks and long standing post-operative collections may evolve in a fistula between two epithelialized structures. Endoscopy has earned a pivotal role in the management of gastrointestinal defects both as first line and as rescue treatment. Endotherapy is a minimally invasive, effective approach with lower morbidity and mortality compared to revisional surgery. Clips and luminal stents are the pioneer of gastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing system and vacuum therapy, has broadened the indications of endoscopy for the management of GI wall defect. Although several endoscopic options are currently used, a standardized evidence-based algorithm for management of GI defect is not available. Successful management of gastrointestinal leaks and fistulae requires a tailored and multidisciplinary approach based on clinical presentation, defect features (size, location and onset time), local expertise and the availability of devices. In this review, we analyze different endoscopic approaches, which we selected on the basis of the available literature and our own experience. Then, we evaluate the overall efficacy and procedural-specific strengths and weaknesses of each approach.
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Affiliation(s)
- Fabrizio Cereatti
- Digestive Endoscopy and Gastroenterology Unit, Cremona Hospital, Cremona, Cremona 26100, Italy
| | - Roberto Grassia
- Digestive Endoscopy and Gastroenterology Unit, Cremona Hospital, Cremona, Cremona 26100, Italy
| | - Andrea Drago
- Digestive Endoscopy and Gastroenterology Unit, Cremona Hospital, Cremona, Cremona 26100, Italy
| | - Clara Benedetta Conti
- Digestive Endoscopy and Gastroenterology Unit, Cremona Hospital, Cremona, Cremona 26100, Italy
| | - Gianfranco Donatelli
- Department of Interventional Endoscopy, Hospital Prive Peupliers, Ramsay Santé, Paris 75013, France
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de Moura DTH, de Moura BFBH, Manfredi MA, Hathorn KE, Bazarbashi AN, Ribeiro IB, de Moura EGH, Thompson CC. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc 2019; 11:329-344. [PMID: 31205594 PMCID: PMC6556487 DOI: 10.4253/wjge.v11.i5.329] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023] Open
Abstract
A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a first-line approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
- Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | | | - Michael A Manfredi
- Esophageal and Airway Atresia Treatment Center, Boston Children's Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Ahmad N Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Igor Braga Ribeiro
- Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | | | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
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Abstract
Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.
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Affiliation(s)
- G Loske
- Department of General, Visceral, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Alfredstr. 9, 22087, Hamburg, Germany.
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Loske G. [Endoscopic negative pressure therapy of the upper gastrointestinal tract. German version]. Chirurg 2018; 89:952-959. [PMID: 30306230 DOI: 10.1007/s00104-018-0728-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.
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Affiliation(s)
- G Loske
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Katholisches Marienkrankenhaus Hamburg gGmbH, Alfredstr. 9, 22087, Hamburg, Deutschland.
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Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc 2017; 32:1906-1914. [DOI: 10.1007/s00464-017-5883-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/13/2017] [Indexed: 01/18/2023]
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Kuehn F, Loske G, Schiffmann L, Gock M, Klar E. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc 2017; 31:3449-3458. [PMID: 28078463 DOI: 10.1007/s00464-016-5404-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative, iatrogenic or spontaneous upper gastrointestinal defects result in significant morbidity and mortality of the patients. In the last few years, endoscopic vacuum therapy (EVT) has been recognized as a new promising method for repairing upper gastrointestinal defects of different etiology. However, probably due to insufficient data and no commercially available system for EVT of the upper gastrointestinal tract, until the end of 2014, covering of esophageal defects with self-expanding metal stents (SEMS) were still the mainstay of endoscopic therapy. The aim of this article is to review the data available about EVT for various upper gastrointestinal defects. METHODS A selective literature search was conducted in Medline and PubMed (2007-2016), taking into account all the published case series and case reports reporting on the use of EVT in the management of upper gastrointestinal defects. RESULTS EVT works through intracorporal application of negative pressure at the defect zone with an electronic controlled vacuum device along a polyurethane sponge drainage. This results in closure of the esophageal defect and internal drainage of the septic focus, simultaneously. Compared to stenting, EVT enables regular viewing of wound conditions with control of the septic focus and adjustment of therapy. Moreover, endoscopical negative pressure is applicable in all esophageal regions (cricopharygeal, tubular, gastroesophageal junction) and in anastomotic anatomic variants. EVT can be used solely as a definite treatment or as a complimentary therapy combined with operative revision. In total, there are published data of more than 200 patients with upper gastrointestinal defects treated with EVT, showing succes rates from 70-100%. CONCLUSION The available data indicate that EVT is feasible, safe and effective with good short-term and long-term clinical outcomes in the damage control of upper GI-tract leaks. Still, a prospective multi-center study has to be conducted to proof the definite benefit of EVT for patients with esophageal defects.
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Affiliation(s)
- Florian Kuehn
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | - Gunnar Loske
- Department for General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, 22087, Hamburg, Germany
| | - Leif Schiffmann
- Westmecklenburg Hospital - Helene von Buelow, 19230, Hagenow, Ludwigslust, Germany
| | - Michael Gock
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Ernst Klar
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
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Krajinovic K, Reimer S, Kudlich T, Germer CT, Wiegering A. "Rendezvous technique" for intraluminal vacuum therapy of anastomotic leakage of the jejunum. Surg Case Rep 2016; 2:114. [PMID: 27757949 PMCID: PMC5069238 DOI: 10.1186/s40792-016-0243-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/13/2016] [Indexed: 02/07/2023] Open
Abstract
Background Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. In recent years, endoluminal vacuum therapy has dramatically changed therapeutic options for AL, but its use has been limited to areas easily accessible by endoscope. Case presentation We describe the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic “rendezvous technique” in which the surgeon assists the endoscopic placement of an endoluminal vacuum therapy sponge in the jejunum by means of a pullback string. This technique led to a completely closed AL after 27 days and 7 changes of the endosponge. Conclusion The combined surgical and endoscopic rendezvous technique can be useful in cases of otherwise difficult endosponge placement.
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Affiliation(s)
- K Krajinovic
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, Julius-Maximilians-University, University of Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany.
| | - S Reimer
- Department of Internal Medicine II, University of Wuerzburg Medical Center, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany
| | - T Kudlich
- Department of Internal Medicine II, University of Wuerzburg Medical Center, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany
| | - C T Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, Julius-Maximilians-University, University of Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, Julius-Maximilians-University, University of Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany. .,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Oberduerrbacherstr. 2, 97074, Wuerzburg, Germany.
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