title: Pre-emptive endoscopic vacuum therapy for treatment of anastomotic ischemia after esophageal resections.
abstract: Background and study aimsEndoscopic vacuum therapy (EVT) is a promising new approach for the treatment of anastomotic leakage in the gastrointestinal tract. Here, we present the first case series demonstrating successful use of EVT for the treatment of post-esophagectomy anastomotic ischemia prior to development of leakage.Patients and methodsBetween 2012 and 2015, intraluminal EVT was performed in eight patients with anastomotic ischemia following esophagectomy. The primary outcome measure was successful mucosal recovery. Secondary outcome measures were duration of treatment, number of sponge changes, septic course, and associated complications.ResultsComplete mucosal recovery was achieved in six patients (75 %) with different degrees of anastomotic ischemia. In two patients (25 %), small anastomotic leaks developed, which resolved by continuing the EVT treatment. Median duration of EVT treatment until mucosal recovery was 16 days (range 6 - 35), with a median of 5 sponge changes per patient (range 2 - 11). No EVT-associated complications were noted. Three patients developed anastomotic stenoses, which were treated by endoscopic dilation therapy.ConclusionThis is the first case series to demonstrate that the early use of EVT potentially modulates clinical outcomes and infection parameters in patients with anastomotic ischemia following esophagectomy. Further studies are needed to define the indications and patients who are most likely to benefit from early EVT.
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
authors.forename: Philipp-Alexander
authors.initials: PA
authors.lastname: Neumann
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mennigen
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Vowinkel
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
authors.forename: Mike G
authors.initials: MG
authors.lastname: Laukoetter
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism; D016099:Endoscopy, Gastrointestinal; D000071041:Esophageal Mucosa / Q000098:blood supply* / Q000502:physiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014618:Vacuum; D014945:Wound Healing
chemical_list: D002097:C-Reactive Protein