title: Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC).
abstract: BACKGROUND
  Esophageal perforations and postoperative leakage of esophagogastrostomy are considered to be life-threatening conditions due to the development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC), a well-established treatment method for superficial infected wounds, is based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy is a novel method, and experience with its esophageal application is limited.
  
  
  METHODS
  This retrospective study summarizes the experience of a center with a high volume of upper gastrointestinal surgery using E-VAC therapy for patients with leakages of the esophagus. The study investigated 14 patients who had esophageal defects treated with E-VAC. Three patients had a spontaneous defect; two patients had an iatrogenic defect; and nine patients had a postoperative esophageal defect.
  
  
  RESULTS
  The average duration of application was 12.1 days, and an average of 3.9 E-VAC systems were used. For 6 of the 14 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. Complete restoration of the esophageal defect was achieved in 12 (86 %) of the 14 patients. Two patients died due to prolonged sepsis.
  
  
  CONCLUSIONS
  This report demonstrates that E-VAC therapy adds an additional treatment option for partial esophageal wall defects. The combination of E-VAC treatment and endoscopic stenting is a successful novel procedure for achieving a high closure rate.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany, marc.bludau@uk-koeln.de.
authors.forename: M
authors.initials: M
authors.lastname: Bludau
authors.forename: A H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: T
authors.initials: T
authors.lastname: Herbold
authors.forename: J M
authors.initials: JM
authors.lastname: Leers
authors.forename: C
authors.initials: C
authors.lastname: Gutschow
authors.forename: H
authors.initials: H
authors.lastname: Fuchs
authors.forename: W
authors.initials: W
authors.lastname: Schröder
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome