Endoscopic vacuum therapy in esophageal defects treatment – our fi rst experience

Česká verzia

Authors: Kateřina Košťálová ^{1 3} ; Zuzana Vacková ¹ ; Radek Pohnán ⁴ ; Tomáš Tyll ⁵ ; Miroslav Zavoral ^1,2 ; Petr Urbánek ¹ ; Štěpán Suchánek ^1,2
Published in the journal: Gastroent Hepatol 2024; 78(4): 306-313
Category: Klinická a experimentální gastroenterologie: přehledová práce
doi: https://doi.org/10.48095/ccgh2024306

Summary

Introduction: Endoscopic vacuum therapy (EVT) has become an important tool in the treatment of esophageal defects such as anastomotic leaks, fistulas and perforations. The study presents the first experience with EVT at the Military University Hospital in Prague. Methods: A retrospective analysis of data from patients treated for esophageal defects using EVT from May 2020 to May 2024 was performed. Patients with completed treatment and 30-day fol low-up were included. EVT was initiated without or in combination with another endoscopic/surgical method. The primary endpoint of the analysis was the success rate of defect closure, the secondary objectives were the duration and characteristics of treatment, 30-day lethality and complications of EVT. Results: Overall, 12 patients have been treated during the study period, of which10 patients (8 men, mean age 65.2 years) completed a 30-day fol low-up and were included into the analysis. In 9/10 cases, the cause of the esophageal defect was anastomotic leak after esophageal surgery, 1 patient had spontaneous esophageal perforation. Successful closure with or without the use of other endoscopic or surgical treatment methods was achieved in 8/10 patients (80%). The mean duration of treatment was 18.9 ± 11.1 days, and the mean number of Eso-SPONGEs used per patient was 5.1 ± 3.4. Two patients (2/10) were treated with EVT alone, 8/10 in combination with another modality. The overall hospitalization lethality was 30%, the 30-day lethality was 20%. Two patients (20%) developed stricture at the site of anastomotic defect, but we have not experienced any ther complications of EVT treatment. Conclusion: EVT has proven to be an effective and safe method for the treatment of esophageal defects, but its success is often achieved in combination with other treatment modalities, especially surgical adjunctive drainage.The treatment is based on multidisciplinary approach and most patients required combination of treatment modalitites.

Keywords:

endoscopic vacuum therapy – esophagectomy – anastomotic leak – esophageal perforation – Eso-SPONGE – VACStent

Zdroje

1. Lang H, Piso P, Stukenborg C et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000; 26 (2): 168–171. doi: 10.1053/ejso.1999.0764.

2. Ikeguchi M, Oka SI, Gomyo Y et al. Postoperative morbidity and mortality after gastrectomy for gastric carcinoma. Hepatogastroenterology 2001; 48 (41): 1517–1520.

3. Weidenhagen R, Gruetzner KU, Wiecken T et al. Endoscopic vacuum-assisted closure of anastomotic leakage fol lowing anterior resection of the rectum: a new method. Surg Endosc 2008; 22 (8): 1818–1825. doi: 10.1007/s00464-007-9706-x.

4. Wedemeyer J, Schneider A, Manns MP et al. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 2008; 67 (4): 708–711. doi: 10.1016/j.gie.2007.10.064.

5. Jung DH, Yun HR, Lee SJ et al. Endoscopic vacuum therapy in patients with transmural defects of the upper gastrointestinal tract: a systematic review with meta-analysis. J Clin Med 2021; 10 (11): 2346. doi: 10.3390/jcm10112346.

6. Aziz M, Haghbin H, Sharma S et al. Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: systematic review and meta-analysis. Endosc Int Open 2021; 9 (9): E1371–E1380. doi: 10.1055/a-1508-5947.

7. Richter F, Hendricks A, Schniewind B et al. Eso-Sponge® for anastomotic leakage after oesophageal resection or perforation: outcomes from a national, prospective multicentre registry. BJS Open 2022; 6 (2): zrac030. doi: 10.1093/bjsopen/zrac030.

8. Luttikhold J, Pattynama LM, Seewald S et al. Endoscopic vacuum therapy for esophageal perforation: a multicenter retrospective cohort study. Endoscopy 2023; 55 (9): 859–864. doi: 10.1055/a-2042-6707.

9. Livingstone I, Pollock L, Sgromo B et al. Cur rent status of endoscopic vacuum therapy in the management of esophageal perforations and post-operative leaks. Clin Endosc 2021; 54 (6): 787–797. doi: 10.5946/ce.2021.240.

10. Stašek M, Aujeský R, Vrba R et al. Successfull therapy of grade III leak after thoracic oesophagectomyusing endoscopic vacuum assisted closure therapy –⁠ a case study. Rozhl Chir 2018; 97 (7): 349–353.

11. Min YW, Kim T, Lee H et al. Endoscopic vacuum therapy for postoperative esophageal leak. BMC Surg 2019; 19 (1): 37. doi: 10.1186/s12893-019-0497-5.

12. Chon SH, Scherdel J, Rieck I et al. 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 fol low-up. Dis Esophagus 2022; 35 (4): doab067. doi: 10.1093/dote/doab067.

13. Lange J, Dormann A, Bulian DR et al. VAC Stent: combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage. Endosc Int Open 2021; 9 (6): E971–E976. doi: 10.1055/a-1474-9932.

14. Kuehn F, Schiffmann L, Janisch F et al. Surgical endoscopic vacuum therapy for defects of the upper gastrointestinal tract. J Gastrointest Surg 2016; 20 (2): 237–243. doi: 10.1007/s11 605-015-3044-4.

15. Heits N, Stapel L, Reichert B et al. Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg 2014; 97 (3): 1029–1035. doi: 10.1016/j.athoracsur.2013.11.014.

16. Smallwood NR, Fleshman JW, Leeds SG et al. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc 2016; 30 (6): 2473–2480. doi: 10.1007/s00464-015-4501-6.

17. Choi SI, Park JC, Shin SK et al. Efficacy of endoscopic vacuum-assisted closure treatment for postoperative anastomotic leak in gastric cancer. Gut Liver 2020; 14 (6): 746–754. doi: 10.5009/gnl20114.

18. Laukoetter MG, Mennigen R, Neumann PA et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 2017; 31 (6): 2687–2696. doi: 10.1007/s00464-016-5265-3.

19. Pournaras DJ, Hardwick RH, Safranek PM et al. Endoluminal vacuum therapy (E-Vac): a treatment option in oesophagogastric surgery. World J Surg 2018; 42 (8): 2507–2511. doi: 10.1007/s00268-018-4463-7.

20. Na B, Kang CH, Na KJ et al. Risk factors of anastomosis stricture after esophagectomy and the impact of anastomosis technique. Ann Thorac Surg 2023; 115 (5): 1257–1264. doi: 10.1016/j.athoracsur.2023.01.026.

21. Biancari F, D’Andrea V, Paone R et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 2013; 37 (5): 1051–1059. doi: 10.1007/s00268-013-1951-7.

ORCID autorů

K. Košťálová 0000-0003-2505-9239,

Z. Vacková 0000-0002-0443-5752,

R. Pohnán 0000-0002-1003-4883,

T. Tyll 0000-0003-4000-3495,

M. Zavoral 0000-0001-7883-7431,

P. Urbánek 0000-0002-8871-7457,

Š. Suchánek 0000-0003-3659-0252.

Doručeno/ Submitted: 21. 5. 2024

Přijato/ Accepted: 29. 7. 2024

Korespondenční autorka

pplk. MUDr. Kateřina Košťálová