scholarly journals International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks

2019 ◽  
Vol 07 (12) ◽  
pp. E1671-E1682 ◽  
Author(s):  
Eduardo Rodrigues-Pinto ◽  
Alessandro Repici ◽  
Gianfranco Donatelli ◽  
Guilherme Macedo ◽  
Jacques Devière ◽  
...  
Keyword(s):  
Balloon Dilation ◽  
Metal Stents ◽  
Vacuum Therapy ◽  
Anastomotic Leaks ◽  
Oncologic Surgery ◽  
Endoscopic Techniques ◽  
Persistent Inflammation ◽  
Small Leak ◽  
Endoscopic Internal Drainage ◽  
Upper Gastrointestinal

Abstract Background and study aims A variety of endoscopic techniques are currently available for treatment of upper gastrointestinal (UGI) anastomotic leaks; however, no definite consensus exists on the most appropriate therapeutic approach. Our aim was to explore current management of UGI anastomotic leaks. Methods A survey questionnaire was distributed among international expert therapeutic endoscopists regarding management of UGI anastomotic leaks. Results A total of 44 % of 163 surveys were returned; 69 % were from gastroenterologists and 56 % had > 10 years of experience. A third of respondents treat between 10 and 19 patients annually. Fifty-six percent use fully-covered self-expandable metal stents as their usual first option; 80% use techniques to minimize migration; 4 weeks was the most common reported stent dwell time. Sixty percent perform epithelial ablation prior to over-the-scope-clip placement or suturing. Regarding endoscopic vacuum therapy (EVT), 56 % perform balloon dilation and intracavitary EVT in patients with large cavities but small leak defects. Regarding endoscopic septotomy, 56 % consider a minimal interval of 4 weeks from surgery and 90 % consider the need to perform further sessions. Regarding endoscopic internal drainage (EID), placement of two stents and shorter stents is preferred. Persistent inflammation with clinical sepsis was the definition most commonly reported for endoscopic failure. EVT/stent placement and EVT/EID were the therapeutic options most often chosen in patients with previous oncologic surgery and previous bariatric surgery, respectively. Conclusions There is a wide variation in the management of patients with UGI anastomotic leaks. Future prospective studies are needed to move from an expert- to evidence- and personalization-based care.

Self-expanding Metal Stents for Anastomotic Leaks After Upper Gastrointestinal Cancer Surgery

2021 ◽  
Vol 267 ◽  
pp. 516-526
Author(s):  
Lukas F. Liesenfeld ◽  
Thomas Schmidt ◽  
Christine Zhang-Hagenlocher ◽  
Peter Sauer ◽  
Markus K. Diener ◽  
...  
Keyword(s):  
Gastrointestinal Cancer ◽  
Cancer Surgery ◽  
Metal Stents ◽  
Anastomotic Leaks ◽  
Upper Gastrointestinal Cancer ◽  
Self Expanding Metal Stents ◽  
Upper Gastrointestinal

VACStent: a new option for endoscopic vacuum therapy in patients with esophageal anastomotic leaks after upper gastrointestinal surgery

Endoscopy ◽  
2019 ◽  
Vol 52 (05) ◽  
pp. E166-E167 ◽  
Author(s):  
Seung-Hun Chon ◽  
Isabel Bartella ◽  
Martin Bürger ◽  
Isabel Rieck ◽  
Tobias Goeser ◽  
...  
Keyword(s):  
Gastrointestinal Surgery ◽  
Vacuum Therapy ◽  
Anastomotic Leaks ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

scholarly journals A Novel Hybrid Stent with Endoscopic Vacuum Therapy for Treating Leaks of the Upper Gastrointestinal Tract

2020 ◽  
pp. 1-7
Author(s):  
Seung-Hun Chon ◽  
Ulrich Töx ◽  
Florian Lorenz ◽  
Isabel Rieck ◽  
Britta Janina Wagner ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Success Rate ◽  
Upper Gastrointestinal Tract ◽  
Metal Stents ◽  
Vacuum Therapy ◽  
Line Treatment ◽  
Promising Alternative ◽  
Number Of Patients ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

<b><i>Introduction:</i></b> Self-expanding metal stents (SEMS) are an established option for treating leaks in the upper gastrointestinal tract, and endoscopic vacuum therapy (EVT) has become a promising alternative. A novel approach is the use of an esophageal hybrid SEMS (VACStent®), which can maintain esophageal passage during EVT. We present the first study demonstrating successful use of the VACStent® for treating leaks of the upper gastrointestinal tract. <b><i>Method:</i></b> We performed a retrospective, single-center study of all patients who underwent endoscopic stenting with the VACStent® of leaks in the upper gastrointestinal tract. <b><i>Results:</i></b> Indications for treatment with the VACStent® were: iatrogenic esophageal perforation (<i>n</i> = 1), spontaneous perforation (<i>n</i> = 2), esophageal fistula (<i>n</i> = 2), and anastomotic leak after upper gastrointestinal surgery (<i>n</i> = 5). Successful application of the VACStent® was achieved in all patients (<i>n</i> = 10; 100%) with a total of 15 interventions. VACStent® therapy was used as a first-line treatment in 5 patient (success rate 80%; 4 out 5 patients) and as a second-line treatment after failed previous endoscopic therapy in 5 patients (success rate 60%; 3 out of 5 patients). Overall, VACStent® treatment was successful in 70% of the patients (7 out of 10). No severe VACStent® treatment-related adverse events occurred. <b><i>Conclusion:</i></b> The initial experience has been that the technical application of the VACStent® is safe and technically feasible. However, due to the small number of patients this study could not show the clear advantages of this novel hybrid stent. More studies are necessary to show significant advantages.

A new hybrid stent using endoscopic vacuum therapy in treating esophageal leaks: a prospective single-center experience of its safety and feasibility with mid-term follow-up

2021 ◽  
Author(s):  
Seung-Hun Chon ◽  
Julia Scherdel ◽  
Isabel Rieck ◽  
Florian Lorenz ◽  
Thomas Dratsch ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
High Energy ◽  
Oral Feeding ◽  
Upper Gastrointestinal Tract ◽  
Metal Stents ◽  
Vacuum Therapy ◽  
Single Center ◽  
Current Form ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

Summary Self-expandable metal stents (SEMS) and endoscopic vacuum therapy (EVT) are endoscopic options for treating leaks of the esophagus. VACStent® is a variant of SEMS that aims to combine the advantages of SEMS and EVT in one device. Due to this unique construction, VACStent® can build a barrier to the leak and facilitate wound healing with EVT, all while maintaining intestinal passage. We present the first prospective feasibility study of VACStent® for treating leaks of the upper gastrointestinal tract. Between September 2019 and November 2020, we performed a prospective, investigator-initiated, single-center study and included all patients who underwent endoscopic stenting with VACStent® for various kinds of esophageal leaks, such as spontaneous, iatrogenic or anastomotic leaks. We included 20 patients, who underwent a total of 24 endoscopic VACStent® implantations. Technical success of the application of the VACStent® was achieved in all interventions (n = 24, 100%). Overall, clinical success in closing the leaks with VACStent® treatment was achieved in 60% of patients (12/20). No severe VACStent® treatment-related adverse events occurred. Oral feeding with supplement high-energy drinks failed in all patients due to clogging of the suction tube. VACStent® is a safe and feasible endoscopic treatment option for leaks of the upper gastrointestinal tract. However, our data could not show the expected advantage of orally feeding the patients during the treatment with the VACStent® in its current form. Efficacy of VACStent® compared to EVT or SEMS needs to be investigated in a further study. ClinicalTrials.gov Identifier: NCT03962179.

Upper Gastrointestinal Endoscopy: Advanced Endoscopic Techniques

2018 ◽  
Author(s):  
Jeffrey Marks ◽  
Hahn Soe-Lin ◽  
Boxiang Jiang
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Metal Stents ◽  
Upper Gastrointestinal Endoscopy ◽  
Upper Endoscopy ◽  
Endoscopic Suturing ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Endoscopic Techniques ◽  
Additional Imaging ◽  
Suturing Techniques ◽  
Upper Gastrointestinal

Advanced endoscopy techniques use the same principles as basic upper endoscopy but involve more complex maneuvers and additional imaging modalities. Most endoscopists after mastering basic upper endoscopy will pursue additional training to become adept with advanced endoscopy techniques. This chapter reviews these techniques. This review contains 9 images, 8 tables, 1 video and 26 references. Key words: endoscopic submucosal dissection, organ sparing endoscopic surgery, submucosal tunneling endoscopic resection, endoluminal bariatric procedures, over the scope clips, endoscopic suturing techniques, endoluminal lumen apposing metal stents

scholarly journals VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage

2021 ◽  
Vol 09 (06) ◽  
pp. E971-E976
Author(s):  
Jonas Lange ◽  
Arno Dormann ◽  
Dirk Rolf Bulian ◽  
Ulrich Hügle ◽  
Claus Ferdinand Eisenberger ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Anastomotic Leakage ◽  
Upper Gastrointestinal Tract ◽  
Metal Stents ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Suction Force ◽  
Oral Nutrition ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

Abstract Background and study aims Endoscopic treatment has markedly improved the high morbidity and mortality in patients with upper gastrointestinal tract leakage. Most procedures employ either covered self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT), both with good clinical success but also with concomitant significant shortcomings inherent in each technique. A newly developed device, the VACStent, combines the fully covered SEMS with a polyurethane sponge cylinder anchored on the outside. This allows endoluminal EVT while keeping the intestinal lumen patent. The benefit is prevention of stent migration because the suction force of the sponge-cylinder immobilizes the VACStent on the intestinal wall, while at the same time, the attached external vacuum pump suctions off any secretions and improves healing with negative-pressure wound treatment (NPWT). Patients and methods In this pilot study, the first patients to receive the VACStent were assessed. Outcomes included the applicability and stability of the VACStent system together with the clinical course. Results Three patients with different clinical courses were managed with the VACStent. The first patient suffered anastomotic leakage following subtotal esophagectomy and was successfully treated with two postoperative VACStents for 12 days. The second patient received a covered SEMS for 14 days for acute Boerhaave syndrome. Due to persistent leakage, management was converted to EVT. Seven days, later a VACStent was inserted to allow oral nutrition while the leak finally closed. In the third patient, a LINX Reflux Management System had to be removed for erosion, leaving the gastroesophageal junction (GEJ) with a full-thickness gap. After VACstent insertion, successful closure was achieved within 4 days. Conclusions These clinical cases demonstrate the applicability and efficacy of the VACstent in management of esophageal and anastomotic leakage. With its vacuum sponge, the stent fosters wound healing while the covered SEMS keeps the passage patent for nutrition.

Sign in / Sign up

Export Citation Format

Share Document