Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta‐analysis

2020 ◽  
Author(s):  
Epifanio Silvino do Monte Junior ◽  
Diogo Turiani Hourneaux de Moura ◽  
Igor Braga Ribeiro ◽  
Kelly Elizabeth Hathorn ◽  
Galileu Ferreira Ayala Farias ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Vacuum Therapy ◽  
Endoscopic Stenting ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

scholarly journals Tu1022 ENDOSCOPIC STENTING VERSUS ENDOSCOPIC VACUUM THERAPY IN THE MANAGEMENT OF UPPER GASTROINTESTINAL TRANSMURAL DEFECTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 91 (6) ◽  
pp. AB506-AB507
Author(s):  
Epifânio S. do Monte ◽  
Diogo T. de Moura ◽  
Pedro Victor Aniz Gomes de Oliveira ◽  
Marina Tucci ◽  
Igor B. Ribeiro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Vacuum Therapy ◽  
Endoscopic Stenting ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

scholarly journals Endoscopic Vacuum Therapy in Patients with Transmural Defects of the Upper Gastrointestinal Tract: A Systematic Review with Meta-analysis

2021 ◽  
Author(s):  
Da Hyun Jung ◽  
Hae-Ryong Yun ◽  
Se Joon Lee ◽  
Na Won Kim ◽  
Cheal Wung Huh
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Sems Placement ◽  
Significant Difference ◽  
Endoscopic Vacuum Therapy ◽  
Estimate Rate ◽  
Upper Gastrointestinal

Abstract A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) has shown rather excellent efficacy in managing UGI defects. We conducted a systematic review and meta-analysis to synthesise the available evidence on the efficacy of EVT in patients with transmural defects of the UGI tract. We searched the PubMed, Cochrane Library, and Embase databases for publications on the effect of EVT on successful closure, mortality, complications, and post-EVT stricture. Methodological quality was assessed using the Newcastle-Ottawa quality assessment scale. This meta-analysis included 29 studies involving 498 participants. The pooled estimate rate of EVT for successful closure was 0.85 (95% confidence interval [CI]: 0.81–0.88). The pooled estimate rate for mortality, complications, and post-EVT stricture was 0.11, 0.10, and 0.14, respectively. According to the aetiology of the transmural defect (perforation vs. leak and fistula), no significant difference was found in successful closure (odds ratio [OR]: 1.45, 95% CI: 0.45–4.67), mortality (OR: 0.77, 95% CI: 0.24–2.46), complications (OR: 0.94, 95% CI: 0.17–5.15), and post-EVT stricture (OR: 0.70, 95% CI: 0.12–4.24). The successful closure rate was significantly higher with EVT than with self-expanding metal stent (SEMS) placement (OR: 3.52, 95% CI: 1.79–6.91). In conclusion, EVT is an effective and safe treatment for treating leaks and fistulae as well as perforations in UGI defects. Moreover, EVT seems to be a better treatment option than SEMS placement in healing UGI defects.

scholarly journals Endoscopic Vacuum Therapy in Patients with Transmural Defects of the Upper Gastrointestinal Tract: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 10 (11) ◽  
pp. 2346
Author(s):  
Da Hyun Jung ◽  
Hae-Ryong Yun ◽  
Se Joon Lee ◽  
Na Won Kim ◽  
Cheal Wung Huh
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Sems Placement ◽  
Closure Rate ◽  
Significant Difference ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) was used for managing UGI defects and showed promising results. We conducted a systematic review and meta-analysis to synthesize evidence on the efficacy of EVT in patients with transmural defects of the UGI tract. We searched the PubMed, Cochrane Library, and Embase databases for publications on the effect of EVT on successful closure, mortality, complications, and post-EVT strictures. Methodological quality was assessed using the Newcastle–Ottawa quality assessment scale. This meta-analysis included 29 studies involving 498 participants. The pooled estimate rate of successful closure with EVT was 0.85 (95% confidence interval [CI]: 0.81–0.88). The pooled estimate rates for mortality, complications, and post-EVT strictures were 0.11, 0.10, and 0.14, respectively. According to the etiology of the transmural defect (perforation vs. leak and fistula), no significant difference was observed in successful closure (odds ratio [OR]: 1.45, 95% CI: 0.45–4.67, p = 0.53), mortality (OR: 0.77, 95% CI: 0.24–2.46, p = 0.66), complications (OR: 0.94, 95% CI: 0.17–5.15, p = 0.94), or post-EVT stricture rates (OR: 0.70, 95% CI: 0.12–4.24, p = 0.70). The successful closure rate was significantly higher with EVT than with self-expanding metal stent (SEMS) placement (OR: 3.14, 95% CI: 1.23–7.98, p = 0.02). EVT is an effective and safe treatment for leaks and fistulae, as well as for perforations in the UGI. Moreover, EVT seems to be a better treatment option than SEMS placement for UGI defects.

Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Vol 52 (08) ◽  
pp. 632-642 ◽  
Author(s):  
Pasquale Scognamiglio ◽  
Matthias Reeh ◽  
Karl Karstens ◽  
Eugen Bellon ◽  
Marcus Kantowski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anastomotic Leakage ◽  
Meta Analysis ◽  
Treatment Success ◽  
Esophageal Surgery ◽  
Metal Stents ◽  
Vacuum Therapy ◽  
Duration Of Treatment ◽  
Median Difference ◽  
Endoscopic Vacuum Therapy

Abstract Background Esophageal anastomotic leakage still represents a challenging complication after esophageal surgery. Endoscopically placed self-expandable metal stents (SEMS) are the treatment of choice, but since the introduction of endoscopic vacuum therapy (EVT) for esophageal leakage 10 years ago, increasing evidence has demonstrated that EVT might be a superior alternative. Therefore, we performed a systematic review and meta-analysis to compare the effectiveness and related morbidity of SEMS and EVT in the treatment of esophageal leak. Methods We systematically searched for studies comparing SEMS and EVT to treat anastomotic leakage after esophageal surgery. Predefined end points including outcome, treatment success, endoscopy, treatment duration, hospitalization time, morbidity, and mortality were assessed and included in the meta-analysis. Results Five retrospective studies including 274 patients matched the inclusion criteria. Compared with stenting, EVT was significantly associated with a higher rate of leak closure (odds ratio [OR] 3.14, 95 % confidence interval [CI] 1.23 to 7.98), more endoscopic device changes (pooled median difference of 3.09; 95 %CI 1.54 to 4.64]), a shorter duration of treatment (pooled median difference –11.90 days; 95 %CI –18.59 to –5.21 days), and a lower mortality rate (OR 0.39, 95 %CI 0.18 to 0.83). There were no significant differences in short-term and major complications. Conclusions Owing to the retrospective quality of the studies with potential biases, the results of the meta-analysis must be interpreted with caution. However, the analysis indicates the potential benefit of EVT, which should be further investigated with standardized and prospectively collected data.

Endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Guilherme Tavares ◽  
Francisco Tustumi ◽  
Luca Schiliró Tristão ◽  
Wanderley Marques Bernardo
Keyword(s):  
Systematic Review ◽  
Anastomotic Leak ◽  
Total Gastrectomy ◽  
Meta Analysis ◽  
Risk Difference ◽  
Vacuum Therapy ◽  
Closure Rate ◽  
Promising Alternative ◽  
Prolonged Length ◽  
Endoscopic Vacuum Therapy

Summary The curative treatment for esophageal and gastric cancer is primarily surgical resection. One of the main complications related to esophagogastric surgery is the anastomotic leak. This complication is associated with a prolonged length of stay, reduced quality of life, high treatment costs, and an increased mortality rate. The placement of endoluminal stents is the most frequent endoscopic therapy in these cases. However, since its introduction, endoscopic vacuum therapy has been shown to be a promising alternative in the management of this complication. This study primarily aims to evaluate the efficacy and safety of endoscopic vacuum therapy for the treatment of anastomotic leak in esophagectomy and total gastrectomy. A systematic review and meta-analysis was performed. Studies that evaluated the use of endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy were included. Twenty-three articles were included. A total of 559 patients were evaluated. Endoscopic vacuum therapy showed a fistulous orifice closure rate of 81.6% (rate: 0.816; 95% CI: 0.777–0.864) and, when compared to the stent, there is a 16% difference in favor of endoscopic vacuum therapy (risk difference [RD]: 0.16; 95% CI: 0.05–0.27). The risk for mortality in the endoscopic vacuum therapy was 10% lower than in endoluminal stent therapy (RD: −0.10; 95% CI: −0.18 to −0.02). Endoscopic vacuum therapy might have a higher rate of fistulous orifice closure and a lower rate of mortality, compared to intraluminal stenting.

626 ENDOSCOPIC VACUUM THERAPY FOR ANASTOMOTIC LEAK IN ESOPHAGECTOMY AND TOTAL GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Guilherme Tavares ◽  
Francisco Tustumi ◽  
Luca Schiliró Tristão ◽  
Maria Carolina Andrade Serafim ◽  
Marina Feliciano Orlandini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anastomotic Leak ◽  
Total Gastrectomy ◽  
Meta Analysis ◽  
Risk Difference ◽  
Vacuum Therapy ◽  
Closure Rate ◽  
Promising Alternative ◽  
Endoscopic Vacuum Therapy ◽  
Esophagogastric Surgery

Abstract   One of the main complications related to esophagogastric surgery, due to esophageal and gastric cancer, is the anastomotic leak. The placement of endoluminal stents is the most frequent endoscopic therapy in these cases. However, since its introduction, endoscopic vacuum therapy has been shown to be a promising alternative. This study primarily aims to evaluate the efficacy and safety of endoscopic vacuum therapy for the treatment of anastomotic leak in esophagectomy and total gastrectomy. Methods A systematic review and meta-analysis was performed. Studies that evaluated the use of endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy were included. Results Twenty-three articles were included. A total of 559 patients were evaluated. Endoscopic vacuum therapy showed a fistulous orifice closure rate of 81.6% (rate: 0.816; 95% CI: 0.777–0.864) and, when compared to the stent, there is a 16% difference in favor of endoscopic vacuum therapy (risk difference [RD]: 0.16; 95% CI: 0.05–0.27). The risk for mortality in the endoscopic vacuum therapy was 10% lower than in endoluminal stent therapy (RD: −0.10; 95% CI: −0.18 to −0.02). Conclusion Endoscopic vacuum therapy might have a higher rate of fistulous orifice closure and a lower rate of mortality, compared to intraluminal stenting.

scholarly journals S0427 Endoscopic Vacuum Therapy for Esophageal Perforation - Are We There? A Systematic Review and Meta-Analysis

2020 ◽  
Vol 115 (1) ◽  
pp. S213-S213
Author(s):  
Yazan Fahmawi ◽  
Faris Hammad ◽  
Yousef Abdel-Aziz ◽  
Sami Ghazaleh ◽  
Lindsey Merritt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Perforation ◽  
Meta Analysis ◽  
Vacuum Therapy ◽  
Endoscopic Vacuum Therapy
Sign in / Sign up

Export Citation Format

Share Document