title: Surgical Endoscopic Vacuum Therapy for Defects of the Upper Gastrointestinal Tract.
abstract: BACKGROUND
  Intraluminal therapy used in the gastrointestinal (GI) tract was first shown for anastomotic leaks after rectal resection. Since a few years vacuum sponge therapy is increasingly being recognized as a new promising method for repairing upper GI defects of different etiology. The principles of vacuum-assisted closure (VAC) therapy remain the same no matter of localization: Continuous or intermittent suction and drainage decrease bacterial contamination, secretion, and local edema. At the same time, perfusion and granulation is promoted. However, data for endoscopic vacuum therapy (EVT) of the upper intestinal tract are still scarce and consist of only a few case reports and small series with low number of patients.
  
  
  OBJECTIVE
  Here, we present a single center experience of EVT for substantial wall defects in the upper GI tract.
  
  
  METHODS
  Retrospective single-center analysis of EVT for various defects of the upper GI tract over a time period of 4 years (2011-2015) with a mean follow-up of 17 (2-45) months was used. If necessary, initial endoscopic sponge placement was performed in combination with open surgical revision.
  
  
  RESULTS
  In total, 126 polyurethane sponges were placed in upper gastrointestinal defects of 21 patients with a median age of 72 years (range, 49-80). Most frequent indication for EVT was anastomotic leakage after esophageal or gastric resection (n = 11) and iatrogenic esophageal perforation (n = 8). The median number of sponge insertions was five (range, 1-14) with a mean changing interval of 3 days (range, 2-4). Median time of therapy was 15 days (range, 3-46). EVT in combination with surgery took place in nine of 21 patients (43 %). A successful vacuum therapy for upper intestinal defects with local control of the septic focus was achieved in 19 of 21 patients (90.5 %).
  
  
  CONCLUSIONS
  EVT is a promising approach for postoperative, iatrogenic, or spontaneous lesions of the upper GI tract. In this series, EVT was combined with operative revision in a relevant proportion of patients.
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. florian.kuehn@med.uni-rostock.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Kuehn
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.|Protestant Hospital Lippstadt, Wiedenbrücker Str. 33, 59555, Lippstadt, Germany.
authors.forename: Leif
authors.initials: L
authors.lastname: Schiffmann
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Janisch
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwandner
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Alsfasser
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gock
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012189:Retrospective Studies; D041742:Upper Gastrointestinal Tract / Q000293:injuries*
keywords: Anastomotic leakage; Endoscopic vacuum therapy; Endoscopy; Esophageal; Perforation