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Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
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Endoluminal Vacuum Therapy: How I Do It.

Steven G Leeds1,2, Marissa Mencio3, Estrellita Ontiveros4,3

  • 1Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Avenue, Suite 1000 East, Dallas, TX, 75246, USA. Steven.leeds@bswhealth.org.

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Summary

Endoluminal vacuum therapy effectively treats gastrointestinal leaks, significantly reducing complications. This endoscopic approach demonstrates high success rates across various GI tract locations, improving patient outcomes.

Keywords:
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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Endoscopy

Background:

  • Gastrointestinal perforations and leaks present significant management challenges, often leading to high morbidity and mortality.
  • Endoscopic techniques have emerged as promising interventions for these complex conditions.
  • Endoluminal vacuum therapy (EVT) represents a recent advancement with notable success in mitigating associated risks.

Purpose of the Study:

  • To review the historical context and evolution of endoluminal wound vacuum therapy.
  • To define patient selection criteria for optimal EVT application.
  • To provide a technical "How I Do It" guide based on clinical experience.

Main Methods:

  • Implementation of an IRB-approved prospective registry initiated in July 2013.
  • Application of endoluminal vacuum therapy using an endosponge and nasogastric tube system.
  • Endoscopic guidance of the device into fistula cavities for therapeutic purposes.

Main Results:

  • High overall success rates for healing GI leaks and fistulas were observed.
  • Specific success rates include 95% for esophageal, 83% for gastric, 100% for small bowel, and 60% for colorectal cases.
  • EVT facilitated healing, source control, and reperfusion of adjacent tissues.

Conclusions:

  • Endoluminal vacuum therapy is a highly effective endoscopic treatment for gastrointestinal leaks and fistulas.
  • The procedure offers a minimally invasive option with significant potential to decrease morbidity and mortality.
  • Careful patient selection and technical proficiency are key to maximizing EVT success rates.