Paradigm Shift for the Treatment of Upper Gastrointestinal Leaks and Perforations: A Retrospective Review of the Use of Endoluminal Vacuum Therapy at One Institution

Nathan Smallwood, MD, Js Burdick, MD, Steven Leeds, MD. Baylor University Medical Center Dallas

Introduction: Upper intestinal leaks and perforations are associated with high morbidity and mortality rates. Despite the experience with endoscopically placed stents the treatment of these leaks and perforations remain a challenge. Endoluminal vacuum (E-Vac) therapy is a novel treatment that has already been successfully used in Germany to treat upper intestinal leaks and perforations. There currently are no reports on its use in the U.S.

Methods: This is a retrospective study summarizing our institutions initial experience with the use of E-Vac therapy to treat esophageal and gastric anastomotic leaks and perforations from September 2013 to September 2014. A total of 6 patients were treated with E-Vac therapy; 1 patient with an iatrogenic esophageal perforation, 1 patient with a post-operative leak following surgical repair of an iatrogenic esophageal perforation, 1 patient with a gastric leak following a delayed surgical repair of a traumatic gastric perforation, 1 spontaneous esophageal perforation, 1 gastric perforation following a Nissen fundoplication, and 1 patient with three gastric perforations and esophagogastric dehiscence following surgery for a presumed paraesophageal hernia. 5 patients with leaks following sleeve gastrectomy were excluded from the study since these patients required a multimodality approach due to their very different pathology.

Results: Four of the six patients (67%) had failed at least one previous attempt at surgical repair, endoscopic stent placement or both prior to use of the E-Vac. Currently treatment is still underway for the patient with a gastric perforation following a Nissen fundoplication. In the remaining 5 patients, all (100%) have undergone complete healing of their defect/s after an average of 41 days of therapy and 7 E-Vac changes. No deaths or complications occurred in any of the patients treated with E-Vac therapy. No patients required esophageal diversion or resection.

Conclusions: E-Vac therapy appears to be an effective and safe treatment modality for upper intestinal leaks and perforations regardless of clinical status and for those who have failed other therapies. E-Vac therapy has become the standard for treatment of these upper gastrointestinal leaks and perforations in our institution.

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