Endoscopy 2021; 53(01): E27-E28
DOI: 10.1055/a-1173-7727
E-Videos

The use of novel modified endoscopic vacuum therapies in the management of a transmural rectal wall defect

Diogo Turiani Hourneaux de Moura
1  Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Epifânio Silvino do Monte Junior
1  Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Kelly E. Hathorn
2  Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Igor Braga Ribeiro
1  Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Flaubert Sena de Medeiros
3  Surgery Department, Universidade Federal de Natal, Natal, Rio Grande do Norte, Brazil
,
Christopher C. Thompson
2  Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Eduardo Guimarães Hourneaux de Moura
1  Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
› Author Affiliations
 

Gastrointestinal transmural defects are difficult to manage and are associated with high rates of morbidity and mortality [1] [2]. Endoscopic vacuum therapy (EVT) has developed into a safe and effective tool for intraluminal treatment of these conditions. However, the high cost of the sponge system may limit a wide spectrum of use [2] [3] [4]. In this video, we describe two cost-effective modified EVTs for treatment of transmural defects.

The first technique is performed using an antimicrobial incise drape, gauze, nasogastric tube (NGT), and nylon suture. First, the antimicrobial drape is cut to fit the fenestrated portion of the NGT. Then, several holes are made in the drape. Next, gauze is wrapped around the fenestrated portion of the NGT, and the gauze is then covered by the antimicrobial drape. Finally, the suture is used to fix the gauze and drape to the NGT ([Fig. 1 a]).

Zoom Image
Fig. 1 Modified endoscopic vacuum therapy systems. a Gauze and antimicrobial incise drape over a nasogastric tube (NGT). b Two NGTs and a nylon suture.

The second technique requires two NGTs and nylon suture thread. First, we cut the distal end of an 18-Fr NGT, then we place a 12-Fr NGT inside the cut end of the 18-Fr NGT, ensuring that the fenestrated portions of the two NGTs do not align. Finally, the suture is used to fix the NGTs together ([Fig. 1 b]).

A 29-year-old woman with familial adenomatous polyposis who had undergone proctocolectomy 2 years earlier, presented with daily fevers and rectal pain. Computed tomography scan demonstrated a leak at the ileorectal anastomosis with an associated fluid collection ([Fig. 2], [Fig. 3 a]). An end-ileostomy was performed. The patient was then treated with a modified EVT system, followed by four EVT system exchanges ([Video 1]). She was discharged from hospital 28 days after the initial procedure ([Fig. 3 b]).

Zoom Image
Fig. 2 Computed tomography scan showing a leak at the ileorectal anastomosis, with an associated fluid collection (arrow).
Zoom Image
Fig. 3 Esophagogastroduodenoscopy. a The leak at the ileorectal anastomosis. b Complete healing of the anastomotic leak after 28 days of endoscopic vacuum therapy.

Video 1 Modified endoscopic vacuum therapy in the management of a transmural rectal wall defect.


Quality:

These novel cost-effective modified EVTs are feasible and appear to be as safe and effective as the traditional sponge EVT system.

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Competing interests

Professor de Moura is a consultant for Olympus and Boston Scientific. Dr. Thompson is a consultant for Boston Scientific, USGI Medical, Fractyl Labs, Olympus, and Apollo Endosurgery.


Corresponding author

Diogo Turiani Hourneaux de Moura, MD, PhD
Endoscopy Unit, Gastrointestinal Department
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Rua Enéas de Carvalho Aguiar 255
São Paulo, SP – 05679-065
Brazil   
Fax: +55-11-26617579   

Publication History

Publication Date:
29 May 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Modified endoscopic vacuum therapy systems. a Gauze and antimicrobial incise drape over a nasogastric tube (NGT). b Two NGTs and a nylon suture.
Zoom Image
Fig. 2 Computed tomography scan showing a leak at the ileorectal anastomosis, with an associated fluid collection (arrow).
Zoom Image
Fig. 3 Esophagogastroduodenoscopy. a The leak at the ileorectal anastomosis. b Complete healing of the anastomotic leak after 28 days of endoscopic vacuum therapy.