Endoscopic vacuum therapy in esophageal defects treatment – our fi rst experience

Czech version

Authors: Kateřina Košťálová ^{1 3}; Zuzana Vacková ¹; Radek Pohnán ⁴; Tomáš Tyll ⁵; Miroslav Zavoral ^1,2; Petr Urbánek ¹; Štěpán Suchánek ^1,2
Published in: Gastroent Hepatol 2024; 78(4): 306-313
Category: Clinical and Experimental Gastroenterology: Review Article
doi: https://doi.org/10.48095/ccgh2024306

Overview

Introduction: Endoscopic vacuum therapy (EVT) has become an important tool in the treatment of esophageal defects such as anastomotic leaks, fistulas and perforations. The study presents the first experience with EVT at the Military University Hospital in Prague. Methods: A retrospective analysis of data from patients treated for esophageal defects using EVT from May 2020 to May 2024 was performed. Patients with completed treatment and 30-day fol low-up were included. EVT was initiated without or in combination with another endoscopic/surgical method. The primary endpoint of the analysis was the success rate of defect closure, the secondary objectives were the duration and characteristics of treatment, 30-day lethality and complications of EVT. Results: Overall, 12 patients have been treated during the study period, of which10 patients (8 men, mean age 65.2 years) completed a 30-day fol low-up and were included into the analysis. In 9/10 cases, the cause of the esophageal defect was anastomotic leak after esophageal surgery, 1 patient had spontaneous esophageal perforation. Successful closure with or without the use of other endoscopic or surgical treatment methods was achieved in 8/10 patients (80%). The mean duration of treatment was 18.9 ± 11.1 days, and the mean number of Eso-SPONGEs used per patient was 5.1 ± 3.4. Two patients (2/10) were treated with EVT alone, 8/10 in combination with another modality. The overall hospitalization lethality was 30%, the 30-day lethality was 20%. Two patients (20%) developed stricture at the site of anastomotic defect, but we have not experienced any ther complications of EVT treatment. Conclusion: EVT has proven to be an effective and safe method for the treatment of esophageal defects, but its success is often achieved in combination with other treatment modalities, especially surgical adjunctive drainage.The treatment is based on multidisciplinary approach and most patients required combination of treatment modalitites.

Keywords:

endoscopic vacuum therapy – esophagectomy – anastomotic leak – esophageal perforation – Eso-SPONGE – VACStent

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ORCID autorů

K. Košťálová 0000-0003-2505-9239,

Z. Vacková 0000-0002-0443-5752,

R. Pohnán 0000-0002-1003-4883,

T. Tyll 0000-0003-4000-3495,

M. Zavoral 0000-0001-7883-7431,

P. Urbánek 0000-0002-8871-7457,

Š. Suchánek 0000-0003-3659-0252.

Doručeno/ Submitted: 21. 5. 2024

Přijato/ Accepted: 29. 7. 2024

Korespondenční autorka

pplk. MUDr. Kateřina Košťálová