Artikel
Endoscopic Vacuum Therapy (EVT) of iatrogenic esophagus perforation
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Autoren
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Gunnar Loske
- katholisches Marienkrankenhaus Hamburg, Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Deutschland
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Tobias Schorsch
- katholisches Marienkrankenhaus Hamburg, Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Deutschland
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Christian Theodor Müller
- katholisches Marienkrankenhaus Hamburg, Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
Text
Background: Endoscopic Vacuum Therapy (EVT) has been reported as a novel treatment option for esophageal leakage. We present our results in the treatment of iatrogenic perforation with EVT in a case series of 11 patients.
Materials and methods: An open-pore polyurethane foam drainage (OPD)was constructed out of an open-pore polyurethane foam and a gastric tube. OPD was placed solely by endoscopic means with a grasper either intracavitary through the perforation defect or intraluminal covering the defect zone. For intraluminal EVT we use foams of 1, 5-2 cm in diameter and up to 12 cm length, for intracavitary placement foam is individually trimmed to an appropriate size. The tube is led out nasally and fixed optionally with nasolabial suture to prevent dislocation. Treatment started immediately after the endoscopic diagnosis. Endoscopies were done with CO2 insufflation and standard gastroscops.
Application of negative pressure (-125) results in suction pressure as well compression pressure on the adjacent tissue. Therefore iatrogenic perforation defect is closed by compression and the perforation area simultaneously drained internal. Contamination of the wound with gastric fluids and saliva is eliminated. Wound secretion and edema are drained permanently into the intraluminal direction opposite of the negative intrathoracic pressure.
Results: Esophageal perforations were located from the cricopharyngeus (5/11) to the esophagogastric junction (2/11). EVT was feasible in all patients. Nine patients were treated with intraluminal EVT, one with intracavitary EVT, and one patient with both typs of treatments.
All perforations (100%) were healed in median within 5 (3-7) days.
No stenosis occurred, no complications were observed, and no additional operative treatment was necessary.
Conclusion: EVT is a safe treatment for iatrogenic esophagus perforations. Placement procedure is easy and mininal-invasive, duration of treatment very short. Our study suggests that intraluminal EVT will play an important role in endoscopic management of iatrogenic esophageal perforation.
Figure 1 [Fig. 1]
