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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2017

01-09-2017 | Review

Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract

Authors: Florian Kuehn, Gunnar Loske, Leif Schiffmann, Michael Gock, Ernst Klar

Published in: Surgical Endoscopy | Issue 9/2017

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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.
Literature
1.
Biancari F, D’Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, Saarnio J, Lucenteforte E (2013) Current treatment and outcome of esophageal perforations in adults: a systematic review and meta-analysis of 75 studies. World J Surg 37:1051–1059CrossRefPubMed
2.
Paspatis GA, Dumonceau JM, Barthet M, Meisner S, Repici A, Saunders BP, Vezakis A, Gonzalez JM, Turino SY, Tsiamoulos ZP, Fockens P, Hassan C (2014) Diagnosis and management of iatrogenic endoscopic perforations: Position Statement from the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 46:1–19
3.
Lang H, Piso P, Stukenborg C, Raab R, Jähne J (2000) Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26:168–171CrossRefPubMed
4.
Kuppusamy MK, Felisky C, Kozarek RA, Schembre D, Ross A, Gan I, Irani S, Low DE (2011) Impact of endoscopic assessment and treatment on operative and non-operative management of acute oesophageal perforation. Br J Surg 98:818–824CrossRefPubMed
5.
Fleischmann W, Strecker W, Bombelli M, Kinzl L (1993) Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg 96:488–492PubMed
6.
Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563–576CrossRefPubMed
7.
Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2008) Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 22:1818–1825CrossRefPubMed
8.
Loske G, Müller C (2009) Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 69:601–602 (author reply 602) CrossRefPubMed
9.
Wedemeyer J, Schneider A, Manns MP, Jackobs S (2008) Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 67:708–711CrossRefPubMed
10.
Loske G, Schorsch T, Müller C (2010) Endoscopic vacuum sponge therapy for esophageal defects. Surg Endosc 24:2531–2535CrossRefPubMed
11.
Mennigen R, Senninger N, Laukoetter MG (2015) Endoscopic vacuum therapy of esophageal anastomotic leakage. Gastrointest Endosc 82:397CrossRefPubMed
12.
13.
Smallwood NR, Fleshman JW, Leeds SG, Burdick JS (2015) The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc 30:2473–2480CrossRefPubMed
14.
Hwang JJ, Jeong YS, Park YS, Yoon H, Shin CM, Kim N, Lee DH (2016) Comparison of endoscopic vacuum therapy and endoscopic stent implantation with self-expandable metal stent in treating postsurgical gastroesophageal leakage. Medicine (Baltimore) 95:e3416CrossRef
15.
Scott RB, Ritter LA, Shada AL, Feldman SH, Kleiner DE (2016) Endoluminal vacuum therapy for gastrojejunal anastomotic leaks after Roux-en-Y gastric bypass: a pilot study in a swine model. Surg Endosc 30:5147–5152CrossRefPubMed
16.
Loske G, Schorsch T, Schmidt-Seithe H, Müller C (2014) Intraluminal endoscopic vacuum therapy in a case of ischemia of the blind end of the jejunal loop after Roux-en-Y gastrectomy. Endoscopy 46(Suppl 1 UCTN):E575–E576. doi:10.​1055/​s-0034-1390913 PubMed
17.
Loske G, Lang U, Schorsch T, Müller CT (2015) Complex vacuum therapy of an abdominal abscess from gastric perforation: case report of innovative operative endoscopic management. Chirurg 86:486–490CrossRefPubMed
18.
Loske G, Rucktäschel F, Schorsch T, van Ackeren V, Stark B, Müller CT (2015) Successful endoscopic vacuum therapy with new open-pore film drainage in a case of iatrogenic duodenal perforation during ERCP. Endoscopy 47:E577–E578CrossRefPubMed
19.
Wedemeyer J, Kubicka S, Lankisch TO, Wirth T, Patecki M, Hiss M, Manns MP, Schneider AS (2012) Transgastrically placed endoscopic vacuum-assisted closure system as an addition to transgastric necrosectomy in necrotizing pancreatitis. Gastrointest Endosc 76:1238–1241CrossRefPubMed
20.
21.
Schorsch T, Muller C, Loske G (2013) Pancreatico-gastric anastomotic insufficiency successfully treated with endoscopic vacuum therapy. Endoscopy 45(Suppl 2 UCTN):E141–E142. doi:10.​1055/​s-0032-1326260 PubMed
22.
Schorsch T, Muller C, Loske G (2014) Endoscopic vacuum therapy of perforations and anastomotic insufficiency of the esophagus. Chirurg 85:1081–1093CrossRefPubMed
23.
Laukoetter MG, Mennigen R, Neumann PA, Dhayat S, Horst G, Palmes D, Senninger N, Vowinkel T (2016) Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. doi:10.​1007/​s00464-016-5265-3 PubMed
24.
Kuehn F, Schiffmann L, Rau BM, Klar E (2012) Surgical endoscopic vacuum therapy for anastomotic leakage and perforation of the upper gastrointestinal tract. J Gastrointest Surg 16:2145–2150CrossRefPubMed
25.
Kuehn F, Schiffmann L, Janisch F, Schwandner F, Alsfasser G, Gock M, Klar E (2016) Surgical endoscopic vacuum therapy for defects of the upper gastrointestinal tract. J Gastrointest Surg 20:237–243CrossRefPubMed
26.
Schniewind B, Schafmayer C, Voehrs G, Egberts J, von Schoenfels W, Rose T, Kurdow R, Arlt A, Ellrichmann M, Jürgensen C, Schreiber S, Becker T, Hampe J (2013) Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc 27:3883–3890CrossRefPubMed
27.
Brangewitz M, Voigtländer T, Helfritz FA, Lankisch TO, Winkler M, Klempnauer J, Manns MP, Schneider AS, Wedemeyer J (2013) Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy 45:433–438CrossRefPubMed
28.
Mennigen R, Harting C, Lindner K, Vowinkel T, Rijcken E, Palmes D, Senninger N, Laukoetter MG (2015) Comparison of endoscopic vacuum therapy versus stent for anastomotic leak after esophagectomy. J Gastrointest Surg 19:1229–1235CrossRefPubMed
29.
Leeds SG, Burdick JS (2016) Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis 12:1278–1285CrossRefPubMed
30.
Wallstabe I, Tiedemann A, Schiefke I (2012) Endoscopic vacuum-assisted therapy of infected pancreatic pseudocyst using a coated sponge. Endoscopy 44(Suppl 2 UCTN):E49–E50. doi:10.​1055/​s-0031-1291525 PubMed
31.
Fischer A, Richter-Schrag HJ, Hoeppner J, Braun A, Utzolino S (2014) Endoscopic intracavitary pull-through vacuum treatment of an insufficient pancreaticogastrostomy. Endoscopy 46(Suppl 1 UCTN):E218–E219. doi:10.​1055/​s-0034-1364951 PubMed
32.
Kuehn F, Klar E, Schwandner F, Alsfasser G, Gock M, Schiffmann L (2014) Endoscopic continuity-preserving therapy for esophageal stenosis and perforation following colliquative necrosis. Endoscopy 46(Suppl 1 UCTN):E361–E362. doi10.​1055/​s-0034-1377283 PubMed
33.
Loske G, Schorsch T, van Ackeren V, Schulze W, Müller CT (2015) Endoscopic vacuum therapy in Boerhaave’s syndrome with open-pore polyurethane foam and a new open-pore film drainage. Endoscopy 47(Suppl 1 UCTN):E410–E411. doi:10.​1055/​s-0034-1392597 PubMed
34.
Loske G, Schorsch T, Gobrecht O, Martens E, Rucktäschel F (2016) Transgastric endoscopic vacuum therapy with a new open-pore film drainage device in a case of infective pancreatic necrosis. Endoscopy 48(Suppl 1):E148–E149PubMed
35.
Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H (2003) Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy 35:652–658CrossRefPubMed
36.
Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J (2005) Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 79:398–403CrossRefPubMed
37.
Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, Epanomeritakis E (2014) The role of esophageal stents in the management of esophageal anastomotic leaks and benign eso-phageal perforations. Ann Surg 259:852–860CrossRefPubMed
38.
Carrott PW Jr, Low DE (2011) Advances in the management of esophageal perforation. Thorac Surg Clin 21:541–555CrossRefPubMed
39.
Schmidt SC, Strauch S, Rosch T, Veltzke-Schlieker W, Jonas S, Pratschke J, Weidemann H, Neuhaus P, Schumacher G (2010) Management of esophageal perforations. Surg Endosc 24:2809–2813CrossRefPubMed
40.
Ahrens M, Schulte T, Egberts J, Schafmayer C, Hampe J, Fritscher-Ravens A, Broering DC, Schniewind B (2010) Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study. Endoscopy 42:693–698CrossRefPubMed
41.
42.
Bludau M, Hölscher AH, Herbold T, Leers JM, Gutschow C, Fuchs H, Schröder W (2014) Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc 28:896–901CrossRefPubMed
43.
Weidenhagen R, Hartl WH, Gruetzner KU, Eichhorn ME, Spelsberg F, Jauch KW (2010) Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg 90:1674–1681CrossRefPubMed
44.
Heits N, Stapel L, Reichert B, Schafmayer C, Schniewind B, Becker T, Hampe J, Egberts JH (2014) Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg 97:1029–1035CrossRefPubMed
Metadata
Title
Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract
Authors
Florian Kuehn
Gunnar Loske
Leif Schiffmann
Michael Gock
Ernst Klar
Publication date
01-09-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5404-x

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