Reply to Dioscoridi et al.

We would like to thank Dr. Dioscoridi and his team for their interest in our recently published study and for their thoughtful comments.

With regard to the timing of the endoscopic treatment of our patients, this piece of information was detailed in the supplementary material attached to the published study. We fully agree that the sooner the endoscopic treatment is initiated, the better the results. Our proposed flowchart advocates for early endoscopic examination and commencement of treatment.

The second point raised by Dioscoridi et al. is about the aspiration tube. They suggest that a single double-channel tube would be enough to achieve a similar effect. We have no experience with these tubes and the aspiration tube that we used was self-made, using ordinary Levine tubes of different diameters. In our experience, using two Levine tubes is cheap, widely available, and easy to locate. We believe that there are several possible designs for the aspiration tubes. To date, we have not found anything better than the tube-in-tube endoscopic vacuum therapy (TT-EVT) technique using Levine tubes.

Finally, Dioscoridi et al. expressed their concern that applying intracavitary negative pressure through the abdominal wall carries a risk of creating a persistent, chronic enterocutaneous fistula. This risk is theoretical and has never happened in our experience. In fact, if the abdominal drain is correctly positioned, the aspiration of the intracavitary content will not be transmitted to the intraluminal space as macrodeformation induces collapse and limits the reach of the negative pressure around the tube.

Publication History

Article published online:
25 May 2023