title: Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study.
abstract: Perforations and anastomotic leakages of the upper gastrointestinal (GI) tract cause a high morbidity and mortality rate. Only limited data exist for endoscopic vacuum therapy (EVT) in the upper GI tract.
  
  
  
  Fifty-two patients (37 men and 15 women, ages 41-94 years) were treated (12/2011-12/2015) with EVT for anastomotic insufficiency secondary to esophagectomy or gastrectomy (n = 39), iatrogenic esophageal perforation (n = 9) and Boerhaave syndrome (n = 4). After diagnosis, polyurethane sponges were endoscopically positioned with a total of 390 interventions and continuous negative pressure of 125 mm of mercury (mmHg) was applied to the EVT-system. Sponges were changed endoscopically twice per week. Clinical and therapy-related data and mortality were analyzed.
  
  
  
  After 1-25 changes of the sponge at intervals of 3-5 days with a mean of 6 sponge changes and a mean duration of therapy of 22 days, the defects were healed in 94.2 % of all patients without revision surgery. In three patients (6 %), EVT failed. Two of these patients died due to hemorrhage related to EVT. Four postinterventional strictures were observed during the follow-up of up to 4 years.
  
  
  
  Esophageal wall defects of different etiology in the upper gastrointestinal tract can be treated successfully with EVT, considering that indication for EVT should be weighed carefully. EVT can be regarded as a novel life-saving therapeutic tool.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany. laukoetter@uni-muenster.de.
authors.forename: Mike G
authors.initials: MG
authors.lastname: Laukoetter
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mennigen
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Neumann
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Sameer
authors.initials: S
authors.lastname: Dhayat
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Horst
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, 48149, Muenster, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Vowinkel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000628:therapy*; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D004939:Esophageal Perforation / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000628:therapy*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D014618:Vacuum; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
keywords: Anastomosis; Endoscopic vacuum therapy; Esophageal perforation; Leak; Postoperative complications; Upper gastrointestinal tract