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      A large anastomotic leakage after esophageal surgery treated with endoluminal vacuum-assisted closure: a case report

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          Abstract

          The treatment of anastomotic post-esophagectomy leaks and fistula is challenging. Endoluminal vacuum-assisted closure (EVAC) is an emerging technique that employs negative pressure wound therapy to treat anastomotic leaks endoscopically. Esosponge is specifically designed for esophageal EVAC therapy. We report on a 49-year-old woman who underwent a totally mini-invasive Ivor–Lewis esophagectomy and developed a giant postoperative leak with a complex pleural collection, but she was not fit for surgical re-intervention. The patient healed almost completely after 14 exchange sessions of Esosponge over 35 days.

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          Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study.

          Mike Laukoetter, Rudolf Mennigen, Philipp Neumann … (2017)
          Perforations and anastomotic leakages of the upper gastrointestinal (GI) tract cause a high morbidity and mortality rate. Only limited data exist for endoscopic vacuum therapy (EVT) in the upper GI tract.
          Article 0 comments Cited 62 times – based on 0 reviews     Review now
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            Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract.

            Florian Kuehn, Gunnar Loske, Leif Schiffmann … (2017)
            Postoperative, iatrogenic or spontaneous upper gastrointestinal defects result in significant morbidity and mortality of the patients. In the last few years, endoscopic vacuum therapy (EVT) has been recognized as a new promising method for repairing upper gastrointestinal defects of different etiology. However, probably due to insufficient data and no commercially available system for EVT of the upper gastrointestinal tract, until the end of 2014, covering of esophageal defects with self-expanding metal stents (SEMS) were still the mainstay of endoscopic therapy. The aim of this article is to review the data available about EVT for various upper gastrointestinal defects.
            Article 0 comments Cited 49 times – based on 0 reviews     Review now
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              Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study.

              J-H Egberts, B Schniewind, A Fritscher-Ravens … (2010)
              Major leakage from an esophageal anastomosis is a life-threatening surgical complication. Endoscopically guided endoluminal vacuum therapy using polyurethane sponges is a new method for treating such leakage. Between June 2007 and June 2009, five patients (mean age 68 years) who developed anastomotic leakage after esophageal surgery were prospectively evaluated. After endoscopic diagnosis of a major leakage, polyurethane sponges were endoscopically positioned in the wound cavity of the anastomosis. Continuous suction was applied via drainage tubes fixed to the sponges. Initially sponges were endoscopically changed three times per week. In all five patients treatment was successful. Median time to reduce levels of inflammation markers by 50 % was 10 days for white blood cell (WBC) count and 7 days for C-reactive protein (CRP). The smallest initial wound cavity size was 42 cm (3) and the largest was 157 cm (3). The median duration of drainage was 28 days, with a median of 9 sponge changes and a median time to total cavity closure of 42 days. Two patients needed anastomotic dilation by Savary-Miller bougienage due to stenosis found on further follow-up. One of these patients died of acute severe hemorrhage from an aortoanastomotic fistula after the dilation procedure. Endoscopically assisted vacuum therapy is a well-tolerated and effective therapeutic option for treatment of major esophageal leaks after surgery. Additional surgery was avoided in all cases. However, the occurrence of a delayed aortoesophageal fistula calls for careful further investigation of this new technique. Copyright Georg Thieme Verlag KG Stuttgart . New York.
              Article 0 comments Cited 38 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: April 2020
                Publication date (Electronic): 24 April 2020
                Publication date PMC-release: 24 April 2020
                Volume: 2020
                Issue: 4
                Electronic Location Identifier: rjaa071
                Affiliations
                [1 ] Division of Gastroenterology and Gastrointestinal Endoscopy , Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
                [2 ] Division of Gastroenterology and Gastrointestinal Endoscopy , Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [3 ] Division of Gastrointestinal Surgery , IRCCS San Raffaele Scientific Institute, Milan, Italy
                Author notes
                Correspondence address. Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, Milan 20132, Italy. Tel: +39-02-2643-6303; E-mail: mandarino.francesco@ 123456hsr.it
                Article
                Publisher ID: rjaa071
                DOI: 10.1093/jscr/rjaa071
                PMC ID: 7180323
                SO-VID: 9a839b34-9719-470c-9b56-b6a7734ed07a
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 5 February 2020
                Date revision received : 4 March 2020
                Date accepted : 6 March 2020
                Page count
                Pages: 4
                Categories
                Subject: Case Report

                Keywords: esophageal leak,esosponge,vacuum therapy,esophagectomy
                Data availability:
                Keywords: esophageal leak, esosponge, vacuum therapy, esophagectomy

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