Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC)

M Bludau, A H Hölscher, T Herbold, J M Leers, C Gutschow, H Fuchs, W Schröder, M Bludau, A H Hölscher, T Herbold, J M Leers, C Gutschow, H Fuchs, W Schröder

Abstract

Background: Esophageal perforations and postoperative leakage of esophagogastrostomy are considered to be life-threatening conditions due to the development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC), a well-established treatment method for superficial infected wounds, is based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy is a novel method, and experience with its esophageal application is limited.

Methods: This retrospective study summarizes the experience of a center with a high volume of upper gastrointestinal surgery using E-VAC therapy for patients with leakages of the esophagus. The study investigated 14 patients who had esophageal defects treated with E-VAC. Three patients had a spontaneous defect; two patients had an iatrogenic defect; and nine patients had a postoperative esophageal defect.

Results: The average duration of application was 12.1 days, and an average of 3.9 E-VAC systems were used. For 6 of the 14 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. Complete restoration of the esophageal defect was achieved in 12 (86 %) of the 14 patients. Two patients died due to prolonged sepsis.

Conclusion: This report demonstrates that E-VAC therapy adds an additional treatment option for partial esophageal wall defects. The combination of E-VAC treatment and endoscopic stenting is a successful novel procedure for achieving a high closure rate.

Figures

Fig. 1
Fig. 1
Intracavitary application of endoluminal vacuum-assisted closure (E-VAC)
Fig. 2
Fig. 2
Intraluminal application of endoluminal vacuum-assisted closure (E-VAC)
Fig. 3
Fig. 3
After endoluminal vacuum-assisted closure (E-VAC) treatment

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Source: PubMed

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