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Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT)
submitted 21 June 2017
accepted after revision 05 March 2018
04 July 2018 (online)
Background and study aims Endoscopic negative pressure therapy (ENPT) has been developed to treat gastrointestinal leakages. Up to now, ENPT has usually been performed with open-pore polyurethane foam drains (OPD). A big disadvantage of the OPDs is their large diameter. We have developed a new, small-bore open-pore film drainage (OFD). Herein we report our first experience in a case series of 16 patients.
Patients and methods OFD is constructed with a drainage tube and a very thin double-layered open-pore drainage film (Suprasorb CNP, Drainage Film, Lohmann & Rauscher International, Germany). The distal end of the tube is wrapped with only one layer of film. OFD is placed into the gastrointestinal leakage site with common endoscopic techniques. The tube is connected to an electronic vacuum device and continuous negative pressure of –125 mmHg applied.
Results From 2013 to 2016, 16 patients were treated with the new OFD device. In 10 patients, transmural intestinal defects (4 esophageal, 4 rectum/colon, 1 duodenal, 1 pancreatic cyst) were closed with ENPT in median time of 12 days (range 3 – 34 days). Five of the 10 patients were treated solely with OFD devices. In five patients ENPT started with ODP and changed to OFD when the cavity was shrunken to a channel with a small opening. In four patients postoperative gastric reflux was eliminated for 5 to 16 days.
Conclusions Small-bore OFD opens up promising new treatment options within ENPT. OFD can be used in endoscopic closure management of intestinal leakages in the upper and lower gastrointestinal tract. Gastric reflux can be eliminated in an active manner. OFD can be inserted nasally. OFD may be an adequate substitute for OPD, especially when placement of the larger OPD is difficult.
Meeting presentations: The authorsʼ experience was first reported in an oral presentation at the 46th Kongress der Deutschen Gesellschaft für Endoskopie und Bildgebende Verfahren in Mannheim (DGE-BV), 17. – 19.03.2016.
- 1 Weidenhagen R, Gruetzner KU, Wiecken T. et al. Endoscopic vacuum-assisted closure of Anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008; 22: 1818-1825
- 2 Loske G, Schorsch T, Muller C. §#/ITL#§ Endoscopic vacuum sponge therapy for esophageal defects. Surg Endosc 2010; 24: 2531-2535
- 3 Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: Endoscopic vacuum therapy and over-the-scope clips. Gastroenterol 2014; 20: 7767-7776
- 4 Loske G, Schorsch T, Müller C. Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy 2011; 43: 540-544
- 5 Loske G, Schorsch T, Gobrecht O. et al. Transgastric endoscopic vacuum therapy with a new open-pore film drainage device in a case of infective pancreatic necrosis. Endoscopy 2016; 48: E148-149
- 6 Loske G, Rucktäschel F, Schorsch T. et al. Successful endoscopic vacuum therapy with new open-pore film drainage in a case of iatrogenic duodenal perforation during ERCP. Endoscopy 2015; 47: E577-E578
- 7 Loske G, Schorsch T, van Ackeren V. et al. Endoscopic vacuum therapy in Boerhaave's syndrome with open-pore polyurethane foam and a new open-pore film drainage. Endoscopy 2015; 47: E410-411
- 8 Loske G, Schorsch T, Kiesow RU. et al. First report of urinary endoscopic vacuum therapy: For large bladder defect after abdomino-perineal excision of the rectum. Video paper. Chirurg 2017; 88: 42-47
- 9 Loske G, Liedke M, Schlöricke E. et al. Endoscopic negative-pressure therapy for duodenal leakage using new open-pore film and polyurethane foam drains with the pull-through technique. Endoscopy 2017; 49: E300-E302
- 10 Kuehn F, Janisch F, Schwandner F. et al. Endoscopic Vacuum Therapy in Colorectal Surgery. J Gastrointest Surg 2016; 20: 328-334
- 11 Kuehn F, Loske G, Schiffmann L. et al. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc 2017; 31: 3449-3458
- 12 Neumann PA, Mennigen R, Palmes D. et al. Pre-emptive endoscopic vacuum therapy for treatment of anastomotic ischemia after esophageal resections. Endoscopy 2017; 49: 498-503
- 13 Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis 2016; 12: 1278-1285
- 14 Fischer A, Thimme R, Hopt UT. et al. Two-sided sponge (TSS) treatment: Description of a novel device and technique for endoscopic vacuum treatment (EVT) in the upper gastrointestinal tract. Endosc Int Open 2016; 4: E937-E940
- 15 Wallstabe I, Tiedemann A, Schiefke I. Endoscopic vacuum-assisted therapy of infected pancreatic pseudocyst using a coated sponge. Endoscopy 2012; 44: E49-E50
- 16 Loske G, Aumiller J, Rucktäschel F. et al. Spontaneous perforation of an intramural esophageal pseudodiverticulosis treated with intraluminal endoscopic vacuum therapy using a double-lumen vacuum drainage with intestinal feeding tube. Endoscopy 2016; 48: E154-E155
- 17 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: 2687-2696
- 18 Schniewind B, Schafmayer C, Both M. et al. Ingrowth and device disintegration in an intralobar abscess cavity during endosponge therapy for esophageal anastomotic leakage. Endoscopy 2011; 43: E64-E65