Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations

Geraldine Ooi, Paul Burton, Andrew Packiyanathan, Damien Loh, Richard Chen, Kalai Shaw, Wendy Brown, Peter Nottle

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

Background: Endoscopic vacuum-assisted closure (EndoVAC) therapy is a recent innovation described for use in upper gastrointestinal perforations and leaks, with reported success of 80-90%. It provides sepsis control and collapses the cavity preventing stasis, encouraging healing of the defect. Whilst promising, initial reports of this new technique have not established clear indications, feasibility and optimal technique. Methods: We analysed all patients who underwent EndoVAC therapy between 2014 and 2016. The technique involved a standard gastroscope, nasogastric tube and vacuum-assisted closure dressing kit, with endoscopic placement of the polyurethane sponge. Data were collected on indication, technique, sepsis control, outcomes and drainage volumes. Results: Ten patients were treated. Average age was 56.7±12.3years. There were three mortalities. EndoVAC placement was feasible in nine patients and successful healing was observed in six patients. Failure was more likely in the cases of large (>8cm), chronic or complex cavities. A three-phase response was seen in successful cases, with initial reduction in external drainage (average: 143-17mL/day within 1week), followed by a progressive reduction in inflammatory markers (2weeks) and finally a healing phase with reduction in cavity size (3weeks). Conclusion: EndoVAC therapy is a potentially useful adjunct to conventional treatments of a subset of upper gastrointestinal leaks and perforations when there is a contained cavity <8cm. It appears less effective in an uncontained perforation or chronically established tract. It has clear advantages of being easily applied with readily available equipment and disposables.

Original languageEnglish
Pages (from-to)E257-E263
Number of pages7
JournalANZ Journal of Surgery
Volume88
Issue number4
DOIs
Publication statusPublished - Apr 2018

Keywords

  • Anastomotic leak
  • Gastroscopy
  • Negative-pressure wound therapy
  • Oesophageal perforation
  • Oesophagectomy

Cite this

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title = "Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations",
abstract = "Background: Endoscopic vacuum-assisted closure (EndoVAC) therapy is a recent innovation described for use in upper gastrointestinal perforations and leaks, with reported success of 80-90{\%}. It provides sepsis control and collapses the cavity preventing stasis, encouraging healing of the defect. Whilst promising, initial reports of this new technique have not established clear indications, feasibility and optimal technique. Methods: We analysed all patients who underwent EndoVAC therapy between 2014 and 2016. The technique involved a standard gastroscope, nasogastric tube and vacuum-assisted closure dressing kit, with endoscopic placement of the polyurethane sponge. Data were collected on indication, technique, sepsis control, outcomes and drainage volumes. Results: Ten patients were treated. Average age was 56.7±12.3years. There were three mortalities. EndoVAC placement was feasible in nine patients and successful healing was observed in six patients. Failure was more likely in the cases of large (>8cm), chronic or complex cavities. A three-phase response was seen in successful cases, with initial reduction in external drainage (average: 143-17mL/day within 1week), followed by a progressive reduction in inflammatory markers (2weeks) and finally a healing phase with reduction in cavity size (3weeks). Conclusion: EndoVAC therapy is a potentially useful adjunct to conventional treatments of a subset of upper gastrointestinal leaks and perforations when there is a contained cavity <8cm. It appears less effective in an uncontained perforation or chronically established tract. It has clear advantages of being easily applied with readily available equipment and disposables.",
keywords = "Anastomotic leak, Gastroscopy, Negative-pressure wound therapy, Oesophageal perforation, Oesophagectomy",
author = "Geraldine Ooi and Paul Burton and Andrew Packiyanathan and Damien Loh and Richard Chen and Kalai Shaw and Wendy Brown and Peter Nottle",
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Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. / Ooi, Geraldine; Burton, Paul; Packiyanathan, Andrew; Loh, Damien; Chen, Richard; Shaw, Kalai; Brown, Wendy; Nottle, Peter.

In: ANZ Journal of Surgery, Vol. 88, No. 4, 04.2018, p. E257-E263.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations

AU - Ooi, Geraldine

AU - Burton, Paul

AU - Packiyanathan, Andrew

AU - Loh, Damien

AU - Chen, Richard

AU - Shaw, Kalai

AU - Brown, Wendy

AU - Nottle, Peter

PY - 2018/4

Y1 - 2018/4

N2 - Background: Endoscopic vacuum-assisted closure (EndoVAC) therapy is a recent innovation described for use in upper gastrointestinal perforations and leaks, with reported success of 80-90%. It provides sepsis control and collapses the cavity preventing stasis, encouraging healing of the defect. Whilst promising, initial reports of this new technique have not established clear indications, feasibility and optimal technique. Methods: We analysed all patients who underwent EndoVAC therapy between 2014 and 2016. The technique involved a standard gastroscope, nasogastric tube and vacuum-assisted closure dressing kit, with endoscopic placement of the polyurethane sponge. Data were collected on indication, technique, sepsis control, outcomes and drainage volumes. Results: Ten patients were treated. Average age was 56.7±12.3years. There were three mortalities. EndoVAC placement was feasible in nine patients and successful healing was observed in six patients. Failure was more likely in the cases of large (>8cm), chronic or complex cavities. A three-phase response was seen in successful cases, with initial reduction in external drainage (average: 143-17mL/day within 1week), followed by a progressive reduction in inflammatory markers (2weeks) and finally a healing phase with reduction in cavity size (3weeks). Conclusion: EndoVAC therapy is a potentially useful adjunct to conventional treatments of a subset of upper gastrointestinal leaks and perforations when there is a contained cavity <8cm. It appears less effective in an uncontained perforation or chronically established tract. It has clear advantages of being easily applied with readily available equipment and disposables.

AB - Background: Endoscopic vacuum-assisted closure (EndoVAC) therapy is a recent innovation described for use in upper gastrointestinal perforations and leaks, with reported success of 80-90%. It provides sepsis control and collapses the cavity preventing stasis, encouraging healing of the defect. Whilst promising, initial reports of this new technique have not established clear indications, feasibility and optimal technique. Methods: We analysed all patients who underwent EndoVAC therapy between 2014 and 2016. The technique involved a standard gastroscope, nasogastric tube and vacuum-assisted closure dressing kit, with endoscopic placement of the polyurethane sponge. Data were collected on indication, technique, sepsis control, outcomes and drainage volumes. Results: Ten patients were treated. Average age was 56.7±12.3years. There were three mortalities. EndoVAC placement was feasible in nine patients and successful healing was observed in six patients. Failure was more likely in the cases of large (>8cm), chronic or complex cavities. A three-phase response was seen in successful cases, with initial reduction in external drainage (average: 143-17mL/day within 1week), followed by a progressive reduction in inflammatory markers (2weeks) and finally a healing phase with reduction in cavity size (3weeks). Conclusion: EndoVAC therapy is a potentially useful adjunct to conventional treatments of a subset of upper gastrointestinal leaks and perforations when there is a contained cavity <8cm. It appears less effective in an uncontained perforation or chronically established tract. It has clear advantages of being easily applied with readily available equipment and disposables.

KW - Anastomotic leak

KW - Gastroscopy

KW - Negative-pressure wound therapy

KW - Oesophageal perforation

KW - Oesophagectomy

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U2 - 10.1111/ans.13837

DO - 10.1111/ans.13837

M3 - Article

VL - 88

SP - E257-E263

JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

IS - 4

ER -