Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España.
Gastroenterol Hepatol. 2020 Oct;43(8):431-438. doi: 10.1016/j.gastrohep.2020.01.019. Epub 2020 Jul 15.
To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract.
This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany).
11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak.
EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.
评估内镜真空治疗（EVT）在上消化道穿孔和吻合口漏中的疗效和安全性。
这是一项回顾性观察研究，纳入了 2017 年 4 月至 2019 年 2 月期间在西班牙三家医院因任何上消化道缺陷而接受 EVT 的患者。为此，我们使用了迄今为止唯一获准用于内镜的医疗设备（Eso-SPONGEr；B. Braun Melsungen AG，德国梅尔松根）。
11 例患者因食管切除术（n=7）、胃切除术（n=2）、内镜 Zenker 隔切开术（n=1）和 Boerhaave 综合征（n=1）后吻合口漏而被转至 EVT。腔的中位大小为 8×3cm。EVT 与手术之间的中位时间为 7 天。EVT 持续时间的中位数为 28 天。使用的海绵中位数为 7 个，平均更换时间为 3.7 天。在 10 例（91%）患者中，缺陷成功闭合。在 9 例（82%）患者中，感染状况的临床缓解得以实现。5 例患者出现了一些不良事件：3 例吻合口狭窄，1 例咽后疼痛和 1 例新发肺炎。从 EVT 开始到住院的中位数为 45 天。1 例患者因吻合口漏继发感染性并发症而死亡。
EVT 在上消化道穿孔和吻合口漏中成功率超过 90%。此外，这是一种安全的治疗方法，仅与轻度不良事件相关。
