Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany.
Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany.
Surg Endosc. 2022 Dec;36(12):9169-9178. doi: 10.1007/s00464-022-09400-w. Epub 2022 Jul 19.
Endoscopic vacuum therapy (EVT) is an effective treatment option for leakage of the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate the clinical impact of quality improvements in EVT management on patients' outcome.
All patients treated by EVT at our center during 2012-2021 were divided into two consecutive and equal-sized cohorts (period 1 vs. period 2). Over time several quality improvement strategies were implemented including the earlier diagnosis and EVT treatment and technical optimization of endoscopy. The primary endpoint was defined as the composite score MTL30 (mortality, transfer, length-of-stay > 30 days). Secondary endpoints included EVT efficacy, complications, in-hospital mortality, length-of-stay (LOS) and nutrition status at discharge.
A total of 156 patients were analyzed. During the latter period the primary endpoint MTL30 decreased from 60.8 to 39.0% (P = .006). EVT efficacy increased from 80 to 91% (P = .049). Further, the need for additional procedures for leakage management decreased from 49.9 to 29.9% (P = .013) and reoperations became less frequent (38.0% vs.15.6%; P = .001). The duration of leakage therapy and LOS were shortened from 25 to 14 days (P = .003) and 38 days to 25 days (P = .006), respectively. Morbidity (as determined by the comprehensive complication index) decreased from 54.6 to 46.5 (P = .034). More patients could be discharged on oral nutrition (70.9% vs. 84.4%, P = .043).
Our experience confirms the efficacy of EVT for the successful management of UGI leakage. Our quality improvement analysis demonstrates significant changes in EVT management resulting in accelerated recovery, fewer complications and improved functional outcome.
内镜下真空治疗（EVT）是治疗上消化道（UGI）漏的有效治疗选择。本研究旨在评估 EVT 管理质量改进对患者预后的临床影响。
将 2012 年至 2021 年在我们中心接受 EVT 治疗的所有患者分为两个连续且大小相等的队列（第 1 期与第 2 期）。随着时间的推移，实施了多项质量改进策略，包括早期诊断和 EVT 治疗以及内镜技术优化。主要终点定义为复合评分 MTL30（死亡率、转移、住院时间＞30 天）。次要终点包括 EVT 疗效、并发症、住院死亡率、住院时间（LOS）和出院时的营养状况。
共分析了 156 例患者。在后期，主要终点 MTL30 从 60.8%降至 39.0%（P=0.006）。EVT 疗效从 80%增加到 91%（P=0.049）。此外，需要额外的漏管管理程序的比例从 49.9%降至 29.9%（P=0.013），再手术的频率降低（38.0%比 15.6%；P=0.001）。漏管治疗和 LOS 的持续时间分别从 25 天缩短至 14 天（P=0.003）和从 38 天缩短至 25 天（P=0.006）。发病率（由综合并发症指数确定）从 54.6%降至 46.5%（P=0.034）。更多的患者可以通过口服营养（70.9%比 84.4%，P=0.043）出院。
我们的经验证实 EVT 对上消化道漏的成功治疗有效。我们的质量改进分析表明，EVT 管理的显著变化导致了恢复加速、并发症减少和功能预后改善。
