Endoscopic vacuum therapy for treatment of rectal stump leakage

Author(s):  
Florian Kühn ◽  
Julia Zimmermann ◽  
Nicola Beger ◽  
Ulrich Wirth ◽  
Sandro M. Hasenhütl ◽  
...  
Author(s):  
Florian Kühn ◽  
Ulrich Wirth ◽  
Julia Zimmermann ◽  
Nicola Beger ◽  
Sandro M. Hasenhütl ◽  
...  

Abstract Background Evidence for endoscopic vacuum therapy (EVT) for colorectal defects is still based on small patient series from various institutions, employing different treatment algorithms and methods. As EVT was invented at our institution 20 years ago, the aim was to report the efficacy and safety of EVT for colorectal defects as well as to analyze factors associated with efficacy, therapy duration, and outpatient treatment. Methods Cohort study with analysis of prospectively collected data of patients receiving EVT for colorectal defects at a tertiary referral center in Germany (n = 281). Results The majority of patients had malignant disease (83%) and an American Society of Anesthesiologists classification of III/IV (81%). Most frequent indications for EVT were anastomotic leakage after sigmoid or rectal resection (67%) followed by rectal stump leakage (20%). EVT was successful in 256 out of 281 patients (91%). EVT following multi-visceral resection (P = 0.037) and recent surgical revision after primary surgery (P = 0.009) were risk factors for EVT failure. EVT-associated adverse events occurred in 27 patients (10%). Median treatment duration was 25 days. Previous chemo-radiation (P = 0.006) was associated with a significant longer duration of EVT. Outpatient treatment was conducted in 49% of patients with a median hospital stay reduction of 15 days and 98% treatment success. Younger patient age (P = 0.044) was associated with the possibility of outpatient treatment. Restoration of intestinal continuity was achieved in 60% of patients where technically possible with a 12-month rate of 52%. Conclusions In patients with colorectal defects, EVT appears to be a safe and effective, minimally invasive option for in- and outpatient treatment.


Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Jung ◽  
Rachel Hallit ◽  
Annegret Müller-Dornieden ◽  
Melanie Calmels ◽  
Diane Goere ◽  
...  

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.


2015 ◽  
Vol 03 (06) ◽  
pp. E547-E551 ◽  
Author(s):  
Gunnar Loske ◽  
Tobias Schorsch ◽  
Christian Dahm ◽  
Eckhard Martens ◽  
Christian Müller

2015 ◽  
Vol 148 (4) ◽  
pp. S-1110
Author(s):  
Florian Kuehn ◽  
Florian Janisch ◽  
Frank Schwandner ◽  
Guido Alsfasser ◽  
Leif Schiffmann ◽  
...  

2020 ◽  
Author(s):  
Chengcheng Christine Zhang ◽  
Lukas Liesenfeld ◽  
Rosa Klotz ◽  
Ronald Koschny ◽  
Christian Rupp ◽  
...  

Abstract BackgroundAnastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening adverse events. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection. MethodsFrom March 2014 to September 2019 259 consecutive patients underwent elective transthoracic esophageal resection. 72 patients (27,8 %) suffered from AL. The overall collective in-hospital mortality rate was 3.9% (n=10). Data from those who underwent treatment with EVT were included. ResultsFifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n=49) by EVT only. The EVT-associated adverse event rate was 5.4% (n=3): bleeding occurred in one patient, while minor sedation-related adverse events were observed in two patients. The median number of EVT procedures per patient was 3. The procedures were performed at intervals of 3-5 days, with a 14-day median duration of therapy. The mortality rate of patients with AL was 7.2% (n=4). Despite successfully terminated EVT, three patients died because of multiple organ failure, acute respiratory distress syndrome, and urosepsis (5.4%). One patient (1.8%) died during EVT due to cardiac arrest. ConclusionsEVT is a safe and effective approach for intrathoracic anastomotic leakages following abdomino-thoracic esophageal resections. It offers a high leakage-closure rate and the potential to lower leakage-related mortalities.


2021 ◽  
pp. 5-16
Author(s):  
Vladimir Alekseevich Porkhanov ◽  
Stanislav Nikolayevich Pyatakov ◽  
Alexander Gennadievich Baryshev ◽  
Denis Mikhailovich Melnik ◽  
Maxim Sergeevich Shevchenko ◽  
...  

This article describes the clinical case of treatment of a patient with perforation of the esophageal wall and mediastinitis by the method of endoscopic vacuum therapy. Endoscopic Vacuum Therapy, also known as Negative Pressure Endoscopic Therapy (E-NPWT, EVT), is an innovative endoscopic option for the treatment of transmural defects in hollow organs, as well as a safe and effective instrument that promotes defect healing through macrodeformation, microdeformation, perfusion changes, controls exudate and bacterial clearance. The goal of endoscopic vacuum therapy is to avoid radical surgical interventions and their complications, as well as to improve patient’s quality of life in the postoperative period.


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