Klose Michelle A, Walldorf Jens, Damm Marko, Krug Sebastian, Klose Johannes, Ronellenfitsch Ulrich, Kleeff Joerg, Michl Patrick, Rosendahl Jonas
Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Saale, Germany.
Department of General, Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Saale, Germany.
Ther Adv Gastrointest Endosc. 2023 Sep 28;16:26317745231200312. doi: 10.1177/26317745231200312. eCollection 2023 Jan-Dec.
Endoscopic approaches in the treatment of transmural esophageal defects, either after esophageal resection or due to perforation, have demonstrated convincing feasibility. Surgical options are limited and associated with high morbidity and mortality rates. Currently, internal endoscopic drainage with pigtail stents, self-expanding metal stent (SEMS), or endoscopic vacuum therapy (EVT) are options for first-line treatment. Here, we report the outcome of the recently developed combination of SEMS and EVT using the endoscopic Microtech-VAC-Stent (EVS).
Between June and July 2022, three consecutive patients (one female and two males) with esophageal transmural defects were treated with the Microtech-VAC-Stent. Two patients suffered from an anastomotic leak after oncologic gastroesophageal surgery, and one patient presented with esophageal perforation due to Boerhaave syndrome.
Three consecutive patients were successfully treated with EVS. In one patient, one EVS treatment was sufficient, whereas the other two patients needed two and six EVS exchanges. Exchanges were scheduled every 7 days and no procedural adverse events were observed.
In line with the former case series, EVS therapy is a promising new approach for the treatment of esophageal leaks. Exchange of the EVS seems feasible every 7 days reducing interventions for the individual patient. Prospective studies comparing EVS with other endoscopic therapies are needed to define the best therapeutic approach.
内镜治疗经壁食管缺损，无论是在食管切除术后还是因穿孔导致的，都已显示出令人信服的可行性。手术选择有限且伴有高发病率和死亡率。目前，猪尾支架、自膨式金属支架（SEMS）或内镜真空治疗（EVT）进行内镜下内部引流是一线治疗选择。在此，我们报告了最近开发的使用内镜Microtech-VAC-Stent（EVS）联合SEMS和EVT的治疗结果。
在2022年6月至7月期间，连续3例经壁食管缺损患者（1例女性和2例男性）接受了Microtech-VAC-Stent治疗。2例患者在肿瘤性胃食管手术后发生吻合口漏，1例患者因博雷尔综合征出现食管穿孔。
连续3例患者均成功接受EVS治疗。1例患者接受1次EVS治疗就足够了，而另外2例患者分别需要进行2次和6次EVS更换。更换安排每7天进行一次，未观察到操作相关不良事件。
与之前的病例系列一致，EVS治疗是一种有前景的食管漏治疗新方法。每7天更换EVS似乎可行，减少了个体患者的干预次数。需要进行前瞻性研究比较EVS与其他内镜治疗方法，以确定最佳治疗方案。
