Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series.
Journal
Surgical laparoscopy, endoscopy & percutaneous techniques
ISSN: 1534-4908
Titre abrégé: Surg Laparosc Endosc Percutan Tech
Pays: United States
ID NLM: 100888751
Informations de publication
Date de publication:
02 Feb 2021
02 Feb 2021
Historique:
received:
08
10
2020
accepted:
15
12
2020
entrez:
16
8
2021
pubmed:
17
8
2021
medline:
25
11
2021
Statut:
epublish
Résumé
The usefulness of endoscopic vacuum therapy (EVT) in the setting of postoperative gastrointestinal leaks is widely described. On this basis, we would like to focus a specific application of EVT: the dehiscence of the duodenal stump after upper gastrointestinal surgery. Standard EVT is not applicable in these cases because of technical limitations (length of overtube and devices). However, vacuum stimulates the healing of leaks and fistulas through granulation tissue's formation and would be effective also in this setting. Between October 2019 and January 2020, 7 consecutive patients (4 M, 3 F, 62±9 y old) affected by duodenal stump's dehiscence were endoscopically treated by the placement of a large-bore (14 to 18 Ch) suction tube across the wall's defect into the peritoneal cavity. Continuous aspiration at -80/-100 mm Hg was applied. Clinical success was established both by fluoroscopic check injecting contrast medium from the tube to verify the fistula's closure and by abdominal computed tomography scan to exclude residual fluid collections. Technical and clinical success were achieved in all the patients. The suction tube was maintained in site for 12±5 days in continuous aspiration. The drainage's output became null in 2±1 days without any intra-abdominal residual fluid collection. The principle of this technique is to let the duodenal walls' stump to collapse on the intraluminal part of the tube (with subsequent mucosal intussusception into the holes of the tube itself) creating a sort of vacuum-packed barrier to interrupt the outflow of enteric materials into the fistula's path. It guarantees the fistula's closure by the gradual formation of granulation tissue. The present technique offers a safe and viable endoscopic alternative to treat duodenal stump's leaks after upper gastrointestinal surgery.
Identifiants
pubmed: 34398131
doi: 10.1097/SLE.0000000000000912
pii: 00129689-202108000-00023
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
502-505Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Babu B, Finch J. Current status in the multidisciplinary management of duodenal fistula. Surgeon. 2013;11:158–164.
Cozzaglio L, Coladonato M, Biffi R, et al. Duodenal fistula after elective gastrectomy for malignant disease: an Italian retrospective multicenter study. J Gastrointest Surg. 2010;14:805–811.
Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014;20:7767–7776.
Bhurwal A, Mutneja H, Tawadross A, et al. Gastrointestinal fistula endoscopic closure techniques. Ann Gastroenterol. 2020;33:554–562.
Loske G. Endoskopische Unterdrucktherapie am oberen Gastrointestinaltrakt [Endoscopic negative pressure therapy of the upper gastrointestinal tract]. Chirurg. 2019;90(suppl 1):1–6.
Yoo T, Hou LA, Reicher S, et al. Successful repair of duodenal perforation with endoscopic vacuum therapy. Gastrointest Endosc. 2018;87:1363–1364.
Eğin S, Gökçek B, Yeşiltaş M, et al. Improvement of a duodenal leak: two-way vacuum-assisted closure. Ulus Travma Acil Cerrahi Derg. 2019;25:89–92.