Endoscopic vacuum assisted closure (E-VAC) of upper gastrointestinal leakages. (2nd November 2021)

• Record Type: Journal Article
• Authors: Book, Thorsten; Wortmann, Nicolas; Winkler, Michael; Kirstein, Martha M.; Heidrich, Benjamin; Wedemeyer, Heiner; Voigtländer, Torsten
• Is Part Of: Scandinavian journal of gastroenterology. Volume 56:Number 11(2021)
• Page Start: 1376
• Page End: 1379
• Publication Date: 2021-11-02
• Subjects: Endoscopic vacuum-assisted closure( E-VAC) -- esophageal perforations -- postoperative leakage -- gastrointestinal leakages -- esophagogastrostomies; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2021.1963836
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Objectives: Endoscopic vacuum-assisted closure (E-VAC) of leaks of the upper gastrointestinal tract is an increasingly applied endoscopic technique. Data on indication, clinical success, complications and prognostic factors are still sparse. Methods: Patients treated with E-VAC between 2012 and 2019 at a tertiary referral center have been retrospectively analyzed. Results: Overall, 116 patients treated with E-VAC were identified. Indication for E-VAC placement was postoperative leakage in 94/116 (81%), iatrogenic perforations 7/116 (6%) and others 15/116 (13%). In 92/116 (79%) of the patients E-VAC therapy showed successful wound closure. The first E-VAC after detection of insufficiency was significantly more often placed intracavitary in patients with E-VAC failure ( p = .031). There was a trend for longer intensive care unit treatment for patients with E-VAC failure ( p = .069). Complications occurred significantly more often in patients with E-VAC failure ( p = .009). Platelet count was significantly higher in patients with E-VAC success at day of insufficiency detection (257/Thsd/µL (interquartile range [IQR], 185–362) vs. 195 (IQR, 117–309); p = .039). Platelet count (375 Thsd/µL (IQR, 256–484) vs. 190 (IQR, 129–292)), hemoglobin (9.5 g/dL (IQR, 8.8–10.1) vs. 8.7 g/dL (IQR, 8.15-9.35)) and C-reactive protein level (79 mg/L (IQR, 39.7-121.9) vs. 152 mg/L (IQR, 73.7-231)) at day 14 differed significantly. The 30 days mortality rate was 33.3% (8/24) in E-VAC failure compared with 2.2% in patients with E-VAC success ( p = .001). Conclusions: E-VAC is an emerging highly effective interventional endoscopic technique for gastrointestinal wound closure even in highly selected patients.