Endoluminal vacuum therapy in the management of a large gastrobronchial fistula.
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ABSTRACT:
SUBMITTER: Durbin S
PROVIDER: S-EPMC7650839 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC6945136 | biostudies-literature
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| S-EPMC7278024 | biostudies-literature
Project description:Video 1Endoluminal vacuum therapy Endo-SPONGE for the treatment of complete dehiscence of low colorectal anastomosis.
| S-EPMC8187130 | biostudies-literature
Project description:BackgroundEndoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leakage. The aim of this study was to evaluate the safety and efficacy of EVT in the treatment of anastomotic leakage and rectal stump insufficiency after Hartmann's procedure.MethodsA systematic search of MEDLINE, Scopus and Cochrane databases was performed using search terms related to EVT and anastomotic leakage or rectal stump insufficiency in line with the PRISMA checklist. Observational studies, RCTs and case series studies published to July 2017 were included. Primary outcomes of the review were the success of EVT, defined as complete or partial healing of the anastomotic defect and associated cavity, and the rate of stoma reversal after EVT. Secondary outcomes included the duration of treatment to complete healing, complications of treatment and the need for further intervention. A meta-analysis was conducted. The potential effect of clinical confounders on the failure of EVT was investigated using the random-effects meta-regression model.ResultsOf 476 articles identified, 17 studies reporting on 276 patients were ultimately included. The weighted mean rate of success was 85·3 (95 per cent c.i. 80·1 to 90·5) per cent, with a median duration from inception of EVT to complete healing of 47 (range 40-105) days. The weighted mean rate of stoma reversal across the studies was 75·9 (64·6 to 87·2) per cent. Twenty-five patients (9·1 per cent) required additional interventions after EVT. Thirty-eight patients (13·8 per cent) developed complications. The weighted mean complication rate across the studies was 11·1 (6·0 to 16·2) per cent. Variables significantly associated with failure included preoperative radiotherapy, absence of diverting stoma, complications and male sex.ConclusionEVT is associated with a high rate of complete healing of anastomotic leakage and stoma reversal. It is an effective option in appropriately selected patients with anastomotic leakage.
| S-EPMC6433422 | biostudies-literature
Project description:Esophageal fistulas in the cervical region are usually difficult to manage and carry a high morbidity. We report a case of an esophago-colonic fistula after colonic interposition, successfully managed with vacuum-assisted closure 'V.A.C. system', (Kinetic Concepts Inc., San Antonio, TX, USA). The patient initially presented with purulent fluid from the cervical wound 13 days after surgery. Esophagogram confirmed a leak. Since the patient had a history of anastomotic leaks, a surgical intervention was not the treatment of choice. In light of this, conservative treatment with V.A.C. system was initiated. She underwent full recovery.
| S-EPMC5755238 | biostudies-literature
Project description:Background and study aims Esophageal defects (leaks, fistulas, and perforations) are associated with significant morbidity and mortality. Endoluminal vacuum-assisted closure (EVAC) is a novel intervention that entails the use of sponges in the defect along with negative pressure to achieve granulation tissue formation and healing and has been gaining popularity. We performed a systematic review and pooled analysis of available literature to assess the safety and effectiveness of EVAC for esophageal defects. Patients and methods We queried PubMed/Medline, Embase, Cochrane, and Web of Science through September 25, 2020 to include all pertinent articles highlighting the safety and effectiveness profile of EVAC for esophageal defects. Pooled rates, 95 % confidence intervals (CIs), and heterogeneity ( I 2 ) were assessed for each outcome. Results A total of 18 studies with 423 patients were included (mean age 64.3 years and males 74.4 %). The technical success for EVAC was 97.1 % (CI: 95.4 %-98.7 %, I 2 = 0 %). The clinical success was 89.4 % (CI: 85.6 %-93.1 %, I 2 = 36.8 %). The overall all-cause mortality and adverse events (AEs) noted were 7.1 % (CI: 4.7 %-9.5 %, I 2 = 0 %) and 13.6 % (CI: 8.0 %-19.1 %, I 2 = 68.9 %), respectively. The pooled need for adjuvant therapy was 15.7 % (CI: 9.8 %-21.6 %, I 2 = 71.1 %). Conclusions This systematic review and meta-analysis showed high rates of technical success, clinical success, and low all-cause mortality and AEs using EVAC. Although the technique is a promising alternative, the lack of comparative studies poses a challenge in making definite conclusions regarding use of EVAC compared to other endoscopic modalities, such as clips and stents.
| S-EPMC8367451 | biostudies-literature
Project description: Not available
| S-EPMC6205932 | biostudies-literature
Project description:IntroductionManagement of enterocutaneous fistula is challenging with high morbidities and mortalities despite the recent advances in surgical technique. The bad outcomes are a result of associated metabolic complications. Vacuum-assisted closure dressing for the management of enterocutaneous fistula is a relatively new technique with benefit as a bridge to definitive surgery or definitive management in achieving spontaneous closure at a shorter time. In the current report, we share our experience of improvising vacuum-assisted closure dressing for managing postoperative enterocutaneous fistula and achieving spontaneous closure PRESENTATION OF CASE: We describe a case of a 56-year-old male from Tanzanian with a postoperative discharge of intestinal contents from the wound. He was diagnosed to have a proximal enterocutaneous fistula. After sepsis control and achieving hemodynamic stability, the enterocutaneous fistula was managed with parenteral nutrition, proton pump inhibitors, anti-cathartics, and somatostatin analogs. Endoscopic therapies and fibrin sealants are other described nonoperative interventions for enterocutaneous fistula. The unavailability of these modalities limited us. Vacuum-assisted closure dressing was improvised using gauze pieces, feeding tube, and Op-site dressings at a pressure of -30 mmHg. We achieved spontaneous closure of the proximal enterocutaneous fistula in 32 days.DiscussionThe time to closure was within the range of 12-90 described for conventional vacuum assisted closure dressing, and there were no complications. Close monitoring of improvised VAC dressings is required as the risks are unknown; however, given the known complications of conventional VAC dressing, a risk of hemorrhage and creation of entero-atmospheric fistula exists.ConclusionImprovised VAC dressing for ECF is potentially an acceptable option with promising outcomes in low-resource settings.
| S-EPMC7708767 | biostudies-literature
Project description:Background and Aims:GI perforations, leaks, and fistulas are types of full-thickness mural defects that frequently occur as adverse events from GI surgeries such as esophagectomy for malignancy and bariatric surgery. Historically, treatment has entailed a combination of reoperation, percutaneous drainage, and bowel rest. Recently, there has been a changing paradigm in the management of these defects. Endoscopic interventions, including endoclipping and placement of self-expanding metal stents (SEMSs), have been increasingly used with good success. Despite this, some defects remain refractory to these techniques. Endoscopic vacuum-assisted closure (EVAC) is a new, promising endoscopic approach to repairing these defects. EVAC works through applying continuous, controlled negative pressure at the defect with the use of an endoscopically placed polyurethane sponge connected to an electronic vacuum device. EVAC has been shown to be feasible, safe, and effective. Methods:We present a video series of 3 cases demonstrating the successful application of EVAC for the treatment of anastomotic leakage after esophagectomy and of fistula formation after bariatric surgery. Results:Two patients experienced anastomotic leakage after esophagectomy for esophageal adenocarcinoma, and 1 patient experienced a chronic gastric fistula after Roux-en-Y gastric bypass. The gastric bypass patient's fistula failed to resolve with over-the-scope-clip placement, and all 3 patients' defects did not heal despite SEMS placement; therefore, EVAC was performed. The bariatric surgery patient required 9 sponge exchanges over 35 days, and the 2 esophagectomy patients each required 3 sponge exchanges over 13 days. All 3 patients had resolution of their defects with EVAC. No adverse events occurred, and all patients have had no recurrence for several months. Conclusions:These cases help to highlight the feasibility, safety, and efficacy of EVAC for the closure of full-thickness GI defects. On the basis of our experience, the use of EVAC should be considered for these complex and refractory cases.
| S-EPMC6318080 | biostudies-other
Project description:Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and pose a significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopic vacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of a polyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention of promoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasingly adopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growing body of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupled with the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has become increasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications, technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight future directions for the use of EVT in esophageal wall defects.
| S-EPMC8652150 | biostudies-literature