Endoscopic Vacuum Therapy via Pharyngostomy: Novel Access for Management of Upper Gastrointestinal Defects

2021 ◽  
pp. 000313482110415
Author(s):  
Manuel Giraldo-Grueso ◽  
Nathan Bolton ◽  
Russell Brown
Keyword(s):  
Oral Intake ◽  
Morbidity Rate ◽  
Vacuum Therapy ◽  
Outpatient Management ◽  
Ivor Lewis ◽  
Mortality And Morbidity ◽  
Ivor Lewis Esophagectomy ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

Background Perforation and anastomotic leakage of the upper gastrointestinal tract (UGI) has a high mortality and morbidity rate. Recently, UGI leaks have been treated with endoscopic vacuum therapy (EVT). However, this technique traditionally requires multiple EVT changes and a prolonged and uncomfortable nasoenteric intubation. We describe our experience using EVT through a novel pharyngostomy access to manage UGI leaks. Methods We describe our development and implementation of EVT via a novel pharyngostomy access to treat a variety of UGI defects. Preoperative, perioperative, and postoperative data were analyzed. Results Six patients with UGI perforations or anastomotic leaks were treated with an EVT using a pharyngostomy access. The median age was 69 years (IQR 53-71). Four patients leaked after an Ivor Lewis esophagectomy, one after a robotic para-esophageal hernia repair, and another after a Roux en Y esophagojejunostomy. Defects were detected on a median of 11.5 days (IQR 3-21). Median values for the duration of the EVT therapy and the number of EVT changes were 19.5 days (IQR 14-31) and 7 (IQR 6.5-9), respectively. Four of the patients were discharged with an EVT in place and were successfully managed as outpatients. At a median follow-up of 8 months, two patients developed strictures. None of the patients required any surgical re-intervention, they tolerated oral intake, and all leakages were confirmed closed by imaging and endoscopy. Discussion Endoscopic vacuum therapy can be successfully managed through a pharyngostomy access, as described. This access is easy, comfortable, and reliable and allows for a transition to outpatient management.

scholarly journals Gastric conduit perforation after Ivor Lewis esophagectomy successfully treated with endoscopic vacuum therapy (E-VAC): a case report

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Selma Hetoja ◽  
Carlo Alberto De Pasqual ◽  
Valentina Mengardo ◽  
Jacopo Weindelmayer ◽  
Simone Giacopuzzi
Keyword(s):  
Gastric Conduit ◽  
Vacuum Therapy ◽  
Intestinal Surgery ◽  
Promising Technique ◽  
Ivor Lewis ◽  
Surgical Closure ◽  
Ivor Lewis Esophagectomy ◽  
First Case ◽  
Life Threatening ◽  
Endoscopic Vacuum Therapy

Abstract Gastric conduit perforation is a life-threatening complication after esophagectomy and currently there is no consensus about its optimal management. Endoscopic vacuum therapy (E-VAC) is a promising technique for the treatment of leaks and perforations after upper gastro-intestinal surgery. We report the case of a 65 years-old male patient who underwent an Ivor Lewis esophagectomy for esophago-gastric junction adenocarcinoma. He referred to our Emergency Department for septic shock and right hydropneumothorax. We performed an emergency thoracoscopy with intraoperative esophagogastroduodenoscopy which showed a pre-pyloric perforation of the gastric conduit. The perforation was initially treated with unsuccessful primary surgical closure and subsequently by means of E-VAC, firstly placed intraluminal and then intracavitary. With the latter technique, we assisted to a progressive clinical improvement until the definitive healing of the perforation. To our knowledge, this is the first case of a gastric tube perforation after esophagectomy successfully treated with E-VAC.

scholarly journals Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michael Tachezy ◽  
Seung-Hun Chon ◽  
Isabel Rieck ◽  
Marcus Kantowski ◽  
Hildegard Christ ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anastomotic Leak ◽  
Vacuum Therapy ◽  
Phase 2 ◽  
Anastomotic Leaks ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Endoscopic Vacuum Therapy ◽  
Eortc Qlq

Abstract Background Intrathoracic anastomotic leaks represent a major complication after Ivor Lewis esophagectomy. There are two promising endoscopic treatment strategies in the case of leaks: the placement of self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT). Up to date, there is no prospective data concerning the optimal endoscopic treatment strategy. This is a protocol description for the ESOLEAK trial, which is a first small phase 2 randomized trial evaluating the quality of life after treatment of anastomotic leaks by either SEMS placement or EVT. Methods This phase 2 randomized trial will be conducted at two German tertiary medical centers and include a total of 40 patients within 2 years. Adult patients with histologically confirmed esophageal cancer, who have undergone Ivor Lewis esophagectomy and show an esophagogastric anastomotic leak on endoscopy or present with typical clinical signs linked to an anastomotic leak, will be included in our study taking into consideration the exclusion criteria. After endoscopic verification of the anastomotic leak, patients will be randomized in a 1:1 ratio into two treatment groups. The intervention group will receive EVT whereas the control group will be treated with SEMS. The primary endpoint of this study is the subjective quality of life assessed by the patient using a systematic and validated questionnaire (EORTC QLQ C30, EORTC QLQ-OES18 questionnaire). Important secondary endpoints are healing rate, period of hospitalization, treatment-related complications, and overall mortality. Discussion The latest meta-analysis comparing implantation of SEMS with EVT in the treatment of esophageal anastomotic leaks suggested a higher success rate for EVT. The ESOLEAK trial is the first study comparing both treatments in a prospective manner. The aim of the trial is to find suitable endpoints for the treatment of anastomotic leaks as well as to enable an adequate sample size calculation and evaluate the feasibility of future interventional trials. Due to the exploratory design of this pilot study, the sample size is too small to answer the question, whether EVT or SEMS implantation represents the superior treatment strategy. Trial registration ClinicalTrials.gov NCT03962244. Registered on May 23, 2019. DRKS-ID DRKS00007941

544 MANAGEMENT OF ACUTE ANASTOMOTIC COMPLICATIONS AFTER IVOR-LEWIS ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Tomas Harustiak ◽  
Jiri Tvrdon ◽  
Alexandr Pazdro ◽  
Martin Snajdauf ◽  
Hana Faltova ◽  
...  
Keyword(s):  
Surgical Revision ◽  
Esophageal Stent ◽  
Individual Treatment ◽  
Vacuum Therapy ◽  
Type I ◽  
Primary Therapy ◽  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Ivor Lewis Esophagectomy ◽  
Surgical Methods

Abstract   Anastomotic leak (AL) and conduit necrosis (CN) are among the most serious surgical complications after esophageal resection. Endoscopic, radiological and surgical methods are used in their treatment. The aim of this paper is to evaluate the results of the treatment of acute anastomotic complications after Ivor-Lewis esophagectomy in a single high-volume center. Methods We performed a retrospective audit of a consecutive cohort of 815 patients undergoing transthoracic esophagectomy with intrathoracic esophago-gastric anastomosis from 2005 to 2019. AL was graded according to Esophagectomy Complications Consensus Group recommendation. Results There were 79 patients with AL and 6 patients with CN (10%). AL type I, II and III was diagnosed in 33 (39%), 25 (29%) and 27 (32%) patients, respectively. Esophageal stent was used in 40 patients. Primary surgical revision (with/without stent insertion) was performed in 14 patients. Reoperation was necessary overall in 25 patients (29%). Seventeen patients (20%) ended-up with esophageal diversion. Treatment with esophageal stent was successful in 28/40 patients (70%). Endoscopic vacuum-therapy was successfully used in three patients for peristent leak after stent extraction. Mortality of severe AL (type II and III) was 10/52 patients (19%). Conclusion Successful management of acute anastomotic complications requires early diagnosis and an individual treatment approach with the use of endoscopic, radiological and surgical methods. The primary attempt for anastomosis preservation using esophageal stent is desirable. Considering the clinical condition and CT finding, we recommend not to hesitate with surgical revision with debridement and drainage of pleural cavity and mediastinum. If primary therapy fails, life-saving procedure is the esophageal diversion.

scholarly journals Simplified nutritional scoring system predicts complicated outcomes of upper gastrointestinal surgery

2017 ◽  
Author(s):  
Juyong Cheong ◽  
Gregory Leighton Falk ◽  
Jigar Darji
Keyword(s):  
Postoperative Complications ◽  
Gastrointestinal Surgery ◽  
Subtotal Gastrectomy ◽  
Postoperative Outcome ◽  
Bowel Function ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
The Mean ◽  
The Relationship ◽  
Upper Gastrointestinal

Abstract Introduction: Postoperative complications after major upper gastrointestinal surgery can be devastating. Malnutrition has been found to be an important risk factor for postoperative complications. However, attempts at trying to detect malnourished patients preoperatively can be cumbersome and complex and are often not done. One simplified way of assessing nutritional status is the ANS system. The aim of this study was to show the relationship between ANS score and the postoperative outcome. Methodology: Medical record of all patients undergoing major EG and HB surgeries at Concord Hospital between 2010 and 2012 were retrospectively analysed. Results: 83 patients were operated and included (1) Whipples' procedure (20.5%), (2) total/subtotal gastrectomy (44.6%), (3) Ivor-Lewis esophagectomy (18%), and (4) distal pancreatectomy (14.5%). The mean ANS score was 1.58. Patients with higher ANS score (2 or more) were found to have significantly higher rates of wound infection (41% vs 12%, p<0.002), anastomotic leaks (13.7% vs 1.92%, p=0.034), unexpected return to operating theatre (31% vs 3.9%, p<0.001), slower return of bowel function as compared to patients with low ANS score (0 or 1). Conclusion: This study demonstrates the importance of screening for malnourished patients prior to their operation. Given its simplicity and effective predictive value, we recommend use of ANS system.

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.

VS03.04: MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH ROBOTIC ASSISTANCE AND IMMUNOFLUORESCENCE: MODULAR STEP UP APPROACH FOR SAFE INTRODUCTION OF NEW TECHNOLOGY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Hans Fuchs ◽  
Rolf Lambertz ◽  
Wolfgang Schröder ◽  
Jessica Leers ◽  
Christiane Bruns
Keyword(s):  
Minimally Invasive ◽  
New Technologies ◽  
Conflicts Of Interest ◽  
New Technology ◽  
Gastrointestinal Surgery ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Center Of Excellence ◽  
Academic Center ◽  
Upper Gastrointestinal

Abstract Description Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Aim of this study is to evaluate the introduction of new technologies in a center of excellence for upper gastrointestinal surgery. Methods A standardized teaching protocol of a complete OR team was performed in simulation and animal models at the center for the future of surgery (San Diego, CA) and IRCAD (Strasbourg, France) to receive certification as console surgeons. Starting 02/2017 the davinci xi and stryker ICG laparoscopy systems were introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n > 300 esophageal cases/year). After simple training procedures based on our minimally invasive expertise were performed, difficulty was increased based on a modular step up approach to safely perform robotic thoracic assisted Ivor Lewis esophagectomy. Results From 02/2017–02/2018, a total of 35 robotic cases were performed. All cases were performed safely without operation-associated complications. Level of difficulty was increased based on our modular step up approach without quality compromises. Video documentation using the new technology is provided. Conclusion The standardized training protocol and our modular step up approach allowed safe introduction of the new technology used. All cases were performed safely without operation-associated complications. Disclosure All authors have declared no conflicts of interest.

Endoscopic Vacuum Therapy for the Treatment of Upper Gastrointestinal Transmural Defects

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S1203
Author(s):  
Rui Morais ◽  
Eduardo Rodrigues-Pinto ◽  
Rodrigo Liberal ◽  
Rui Gaspar ◽  
Cristina Fernandes ◽  
...  
Keyword(s):  
Vacuum Therapy ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

P12 LONG-TERM QUALITY OF LIFE AFTER TOTAL GASTRECTOMY VERSUS IVOR LEWIS ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E Jezerskyte ◽  
L M Saadeh ◽  
E R C Hagens ◽  
M A G Sprangers ◽  
L Noteboom ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Nausea And Vomiting ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Significant Difference

Abstract Aim The aim of this study was to investigate the difference in long-term health-related quality of life in patients undergoing total gastrectomy versus Ivor Lewis esophagectomy in a tertiary referral center. Background & Methods Surgical treatment for gastroesophageal junction (GEJ) cancers is challenging. Both a total gastrectomy and an esophagectomy can be performed. Which of the two should be preferred is unknown given the scarce evidence regarding effects on surgical morbidity, pathology, long-term survival and health-related quality of life (HR-QoL). From 2014 to 2018, patients with a follow-up of > 1 year after either a total gastrectomy or an Ivor Lewis esophagectomy for GEJ or cardia carcinoma completed the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. Problems with eating, reflux and nausea and vomiting were chosen as the primary HR-QoL endpoints. The secondary endpoints were the remaining HR-QoL domains, postoperative complications and pathology results. Multivariable linear regression was applied taking confounders age, gender, ASA classification and neoadjuvant therapy into account. Results 30 patients after gastrectomy and 71 after Ivor Lewis esophagectomy with a mean age of 63 years were included. Median follow-up was two years (range 12-84 months). Patients after total gastrectomy reported significantly less choking when swallowing and coughing (β=-5.952, 95% CI -9.437 – -2.466; β=-13.084, 95% CI -18.525 – -7.643). Problems with eating, reflux and nausea and vomiting were not significantly different between the two groups. No significant difference was found in postoperative complications or Clavien-Dindo grade. Significantly more lymph nodes were resected in esophagectomy group (p=0.008). No difference in number of positive lymph nodes or R0 resection was found. Conclusion After a follow-up of > 1 year choking when swallowing and coughing were less common after total gastrectomy. No significant difference was found in problems with eating, reflux or nausea and vomiting nor in postoperative complications or radicality of surgery. Based on this study no general preference can be given to either of the procedures for GEJ cancer. Patients may be informed about the HR-QoL domains that are likely to be affected by the different surgical procedures, which in turn may support shared decision making when a choice between the two treatment options is possible.

P42 EFFICACY OF ENDOSCOPIC TREATMENT FOR CONTAINED LEAKAGE AFTER IVOR LEWIS ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
M Lubbers ◽  
Workum F van ◽  
G Berkelmans ◽  
C Rosman ◽  
MD Luyer ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Approach ◽  
Endoscopic Treatment ◽  
Treatment Strategies ◽  
Oral Intake ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Stay Time ◽  
Multicentre Cohort ◽  
Surgical Group

Abstract Aim Anastomotic leakage after esophagectomy (AL) is a severe complication that often needs aggressive and invasive treatment. However, there is no consensus on what strategy is best. The aim of this study was to analyse the different treatment strategies for AL and evaluate their outcomes. Background and methods A retrospective analysis was performed on all patients who developed AL after Ivor Lewis Esophagectomy (IL) from January 2011 until September 2016 in three high volume hospitals. Treatment of AL was based on local expertise, without common guideline. The different treatment strategies (surgical and endoscopic) were compared for patients with contained (confined to the mediastinum) and uncontained AL (leakage with intrapleural complications). Endpoints were the amount of re-interventions, readmission to the ICU, ICU- and hospital stay, time to restart oral feeding and mortality. Results Seventy-three patients with AL were identified in this multicentre cohort with either a contained or an uncontained leak. Basic variables were similar in both groups. A contained leak was identified in 39 patients. An endoscopic approach was chosen in 25 patients (64%) and was successful in 19 (76%). Fourteen patients (36%) were primarily treated with a surgical approach that was successful in 11 (79%). Significantly more patients were (re)admitted to the ICU in the surgical group versus the endoscopic group (100% vs 52%, p=0.003). The ICU and hospital stay, time to restart oral intake and mortality were not significantly different in both groups. An uncontained leak was seen in 34 patients. Endoscopic treatment was chosen in 14 patients (41%) and was successful in 10 (71%). A surgical approach was performed in 20 patients (59%) and was successful in 12 (60%). (Re)admission rate to the ICU was significantly higher in the surgical group (95% vs 57%, p=0.012). The ICU- and hospital stay and time to restart oral intake were similar. There was no mortality in this cohort. Conclusion The classification of leakages into contained and uncontained might help to determine treatment strategy. In this multicentre cohort, the endoscopic approach for contained leaks appears to be feasible and successful. The operative approach remains the preferred option for uncontained anastomotic leakage.

Sign in / Sign up

Export Citation Format

Share Document