Management of Nonmalignant Tracheo- and Bronchoesophageal Fistula after Esophagectomy

2020 ◽  
Author(s):  
Daniel Palmes ◽  
Linus Kebschull ◽  
Ralf Bahde ◽  
Norbert Senninger ◽  
Andreas Pascher ◽  
...  
Keyword(s):  
Conservative Therapy ◽  
Vacuum Therapy ◽  
Complication Management ◽  
Defect Closure ◽  
Bronchoesophageal Fistula ◽  
Esophageal Stents ◽  
Good General Condition ◽  
Endoscopic Vacuum Therapy ◽  
Tracheal Bifurcation ◽  
Time Point

Abstract Background Tracheo- or bronchoesophageal fistula (TBF) occurring after esophagectomy represent a rare but devastating complication. Management remains challenging and controversial. Therefore, the purpose of this study was to evaluate the outcome of different treatment approaches and to propose recommendations for the management of TBF. Methods From 2008 to 2018, 15 patients were treated because of TBF and were analyzed with respect to fistula appearance, treatment strategy (stenting, endoscopic vacuum therapy and/or surgical reintervention) and outcome. Results In each case, the fistula was small, located close to the tracheal bifurcation and associated simultaneously (n = 6, 40%) or metachronously (n = 9, 60%) with an anastomotic leakage. Latter was covered by esophageal stents in six patients which in turn resulted in occurrence of TBF at a later time in five patients. Management of TBF included conservative therapy (n = 3), stenting (n = 6), or suturing (n = 6). Ten patients underwent rethoracotomy. Treatment failure was observed in eight patients (53%). In all patients, treatment was accompanied by progressive sepsis. On the contrary, all seven patients with successful defect closure remained in good general condition. Conclusion Fistula appearance was similar in all patients. Implementation of esophageal stents cannot be recommended because of possibility of TBF at a later time point. Surgery is usually required and should preferably be performed when the patient's condition has been optimized at a single-stage repair. Esophageal diversion can only be recommended in patients with persisting mediastinitis. The key element for successful treatment of TBF, however, is control over sepsis; otherwise, outcome of TBF is devastating.

Endoscopic Vacuum Therapy (EVT)—a New Concept for Complication Management in Bariatric Surgery

2017 ◽  
Vol 27 (9) ◽  
pp. 2499-2505 ◽  
Author(s):  
Fabian Schmidt ◽  
Rudolf Mennigen ◽  
Thorsten Vowinkel ◽  
Philipp A. Neumann ◽  
Norbert Senninger ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Vacuum Therapy ◽  
Complication Management ◽  
Endoscopic Vacuum Therapy

Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Jung ◽  
Rachel Hallit ◽  
Annegret Müller-Dornieden ◽  
Melanie Calmels ◽  
Diane Goere ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Treatment Duration ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Gastrointestinal Surgery ◽  
Vacuum Therapy ◽  
Internal Drainage ◽  
Upper Gi ◽  
Endoscopic Internal Drainage ◽  
Endoscopic Vacuum Therapy

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.

scholarly journals Iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT)

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

Surgical treatment of rapidly advancing active ulcerative colitis: a case report

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (3) ◽  
Author(s):  
Sławomir Glinkowski ◽  
Daria Marcinkowska
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Presentation ◽  
Histopathological Examination ◽  
Vacuum Therapy ◽  
Active Ulcerative Colitis ◽  
Packed Red Blood Cells ◽  
Surgical Department ◽  
Bacterial Aetiology ◽  
Good General Condition ◽  
Impaired Immune Response

Ulcerative colitis is an inflammatory bowel disease with various clinical presentation. Due to an impaired immune response, diffuse inflammation develops in the intestinal tissue, which leads to bleeding and diarrhoea. The basis for diagnosis is the clinical presentation and the result of colonoscopy which confirms the presence of inflammatory lesions in the colon. The authors present the case of a patient admitted to their department following two previous hospitalisations at other centres who was suffering from active ulcerative colitis. After bacterial aetiology of the disease was excluded and conservative treatment was attempted at a gastroenterology ward, the patient was referred to a surgical department. During the previous hospitalisation colonoscopy was performed in which a lesion was observed in the splenic flexure, which precluded the visualisation of the further part of the colon. A colonoscopy performed at the surgical department did not confirm the presence of that lesion; however, it did reveal multiple pseudopolyps. Due to rapidly progressing cachexia and anaemia and a lack of improvement following attempted pharmacological treatment, a decision was made to perform an urgent colectomy with end ileostomy. After a week-long preparation of the patient (parenteral nutrition, packed red blood cells transfusion), pancolectomy was performed. Histopathological examination confirmed acute phase ulcerative colitis. In the postoperative period massive wound infection developed, which was treated for 14 days with vacuum therapy (VAC). The patient was treated for 30 days at the surgical department. He was discharged in a good general condition and instructed to report to his outpatient care centre.

478 Surgical Endoscopic Vacuum Therapy for Defects of the Upper GI Tract

2015 ◽  
Vol 148 (4) ◽  
pp. S-1110
Author(s):  
Florian Kuehn ◽  
Florian Janisch ◽  
Frank Schwandner ◽  
Guido Alsfasser ◽  
Leif Schiffmann ◽  
...  
Keyword(s):  
Vacuum Therapy ◽  
Gi Tract ◽  
Upper Gi ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gi Tract

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

2020 ◽  
Author(s):  
Chengcheng Christine Zhang ◽  
Lukas Liesenfeld ◽  
Rosa Klotz ◽  
Ronald Koschny ◽  
Christian Rupp ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Anastomotic Leakage ◽  
Esophageal Resection ◽  
Median Number ◽  
Adverse Event Rate ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Closure Rate ◽  
Endoscopic Vacuum Therapy

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.

Role and possibilities of endoscopic Vacuum Therapy in the treatment of transmural defects of upper gastrointestinal tract

2021 ◽  
pp. 5-16
Author(s):  
Vladimir Alekseevich Porkhanov ◽  
Stanislav Nikolayevich Pyatakov ◽  
Alexander Gennadievich Baryshev ◽  
Denis Mikhailovich Melnik ◽  
Maxim Sergeevich Shevchenko ◽  
...  
Keyword(s):  
Endoscopic Therapy ◽  
Esophageal Wall ◽  
Vacuum Therapy ◽  
Bacterial Clearance ◽  
Surgical Interventions ◽  
Defect Healing ◽  
Effective Instrument ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

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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