Endoscopy 2017; 49(05): 498-503
DOI: 10.1055/s-0042-123188
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Pre-emptive endoscopic vacuum therapy for treatment of anastomotic ischemia after esophageal resections

Philipp-Alexander Neumann
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
,
Rudolf Mennigen
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
,
Daniel Palmes
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
,
Norbert Senninger
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
,
Thorsten Vowinkel
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
,
Mike G. Laukoetter
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
› Author Affiliations
Further Information

Publication History

submitted 20 June 2016

accepted after revision 08 November 2016

Publication Date:
20 January 2017 (online)

Abstract

Background and study aims Endoscopic vacuum therapy (EVT) is a promising new approach for the treatment of anastomotic leakage in the gastrointestinal tract. Here, we present the first case series demonstrating successful use of EVT for the treatment of post-esophagectomy anastomotic ischemia prior to development of leakage.

Patients and methods Between 2012 and 2015, intraluminal EVT was performed in eight patients with anastomotic ischemia following esophagectomy. The primary outcome measure was successful mucosal recovery. Secondary outcome measures were duration of treatment, number of sponge changes, septic course, and associated complications.

Results Complete mucosal recovery was achieved in six patients (75 %) with different degrees of anastomotic ischemia. In two patients (25 %), small anastomotic leaks developed, which resolved by continuing the EVT treatment. Median duration of EVT treatment until mucosal recovery was 16 days (range 6 – 35), with a median of 5 sponge changes per patient (range 2 – 11). No EVT-associated complications were noted. Three patients developed anastomotic stenoses, which were treated by endoscopic dilation therapy.

Conclusion This is the first case series to demonstrate that the early use of EVT potentially modulates clinical outcomes and infection parameters in patients with anastomotic ischemia following esophagectomy. Further studies are needed to define the indications and patients who are most likely to benefit from early EVT.

 
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