Pines Guy, Bar Ilan, Elami Amir, Sapojnikov Shimon, Hikri Ofir, Ton Dennis, Mosenkis Bruce, Melzer Ehud
1 Department of Thoracic Surgery, Kaplan Medical Center and The Hebrew University School of Medicine , Rehovot, Israel .
2 Department of Surgery, Kaplan Medical Center and The Hebrew University School of Medicine , Rehovot, Israel .
J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):33-40. doi: 10.1089/lap.2017.0318. Epub 2017 Oct 11.
Endoscopic vacuum-assisted closure (EVAC) therapy is increasingly being used as a new promising method for repairing upper gastrointestinal defects of different etiologies with high success rates. EVAC therapy consists of placing a sponge either within the lumen or within an abscess cavity connected with a nasogastric (NG) tube to a negative pressure system, thus decreasing bacterial contamination and edema and promoting granulation tissue proliferation, thereby gradually decreasing the cavity size until complete closure. Herein, we describe a modified technique for EVAC therapy in which the NG tube is passed into the esophagus through an existing intrapleural drain tract using a rendezvous technique. The small residual fistula was amendable to fibrin glue embolization. This allows easier sponge placement and exchange compared to traditional EVAC technique, and allows oral intake during treatment. We also review the literature regarding other endoscopic treatment options for esophageal anastomotic leaks and perforations.
The PubMed database was searched using the terms "esophagus," "esophageal," "leak," "fistula," "endoluminal vacuum-assisted closure (VAC)," "endoscopic VAC," "stent," "sealant," "glue," and "over-the-scope clip (OTSC)." Reference lists of identified articles were searched for further articles, and the "similar articles" function was used on all included articles.
Complete closure of the nonhealing fistula was achieved after 8 days of EVAC treatment and fibrin glue embolization.
Modified EVAC technique as described is feasible and safe. To the best of our knowledge, this is the first description of this technique. The technique allows easier sponge placement and exchange compared to traditional EVAC technique, and allows oral intake during treatment.
内镜下真空辅助闭合（EVAC）疗法正越来越多地被用作一种新的、有前景的方法来修复不同病因的上消化道缺损，成功率很高。EVAC疗法包括将一块海绵置于管腔内或与鼻胃管相连的脓肿腔内，并连接到负压系统，从而减少细菌污染和水肿，促进肉芽组织增殖，进而逐渐减小腔隙大小直至完全闭合。在此，我们描述一种改良的EVAC治疗技术，即使用会师技术通过现有的胸腔引流通道将鼻胃管插入食管。小的残余瘘适合用纤维蛋白胶栓塞。与传统的EVAC技术相比，这使得海绵放置和更换更容易，并且在治疗期间允许经口进食。我们还回顾了有关食管吻合口漏和穿孔的其他内镜治疗选择的文献。
使用“食管”“食管的”“漏”“瘘”“腔内真空辅助闭合（VAC）”“内镜下VAC”“支架”“密封剂”“胶水”和“套扎器（OTSC）”等术语检索PubMed数据库。对已识别文章的参考文献列表进行进一步检索，并对所有纳入文章使用“相似文章”功能。
经过8天的EVAC治疗和纤维蛋白胶栓塞后，未愈合的瘘完全闭合。
所描述的改良EVAC技术是可行且安全的。据我们所知，这是对该技术的首次描述。与传统的EVAC技术相比，该技术使得海绵放置和更换更容易，并且在治疗期间允许经口进食。
