VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage
Background and study aims Endoscopic treatment has markedly improved the high morbidity and mortality in patients with upper gastrointestinal tract leakage. Most procedures employ either covered self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT), both with good clinical success bu...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2021-05-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1474-9932 |
| _version_ | 1819097570825207808 |
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| author | Jonas Lange Arno Dormann Dirk Rolf Bulian Ulrich Hügle Claus Ferdinand Eisenberger Markus Maria Heiss |
| author_facet | Jonas Lange Arno Dormann Dirk Rolf Bulian Ulrich Hügle Claus Ferdinand Eisenberger Markus Maria Heiss |
| author_sort | Jonas Lange |
| collection | DOAJ |
| description | Background and study aims Endoscopic treatment has markedly improved the high morbidity and mortality in patients with upper gastrointestinal tract leakage. Most procedures employ either covered self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT), both with good clinical success but also with concomitant significant shortcomings inherent in each technique. A newly developed device, the VACStent, combines the fully covered SEMS with a polyurethane sponge cylinder anchored on the outside. This allows endoluminal EVT while keeping the intestinal lumen patent. The benefit is prevention of stent migration because the suction force of the sponge-cylinder immobilizes the VACStent on the intestinal wall, while at the same time, the attached external vacuum pump suctions off any secretions and improves healing with negative-pressure wound treatment (NPWT).
Patients and methods In this pilot study, the first patients to receive the VACStent were assessed. Outcomes included the applicability and stability of the VACStent system together with the clinical course.
Results Three patients with different clinical courses were managed with the VACStent. The first patient suffered anastomotic leakage following subtotal esophagectomy and was successfully treated with two postoperative VACStents for 12 days. The second patient received a covered SEMS for 14 days for acute Boerhaave syndrome. Due to persistent leakage, management was converted to EVT. Seven days, later a VACStent was inserted to allow oral nutrition while the leak finally closed. In the third patient, a LINX Reflux Management System had to be removed for erosion, leaving the gastroesophageal junction (GEJ) with a full-thickness gap. After VACstent insertion, successful closure was achieved within 4 days.
Conclusions These clinical cases demonstrate the applicability and efficacy of the VACstent in management of esophageal and anastomotic leakage. With its vacuum sponge, the stent fosters wound healing while the covered SEMS keeps the passage patent for nutrition. |
| first_indexed | 2024-12-22T00:17:12Z |
| format | Article |
| id | doaj.art-fd2cdbc097b74957910a34a1d67900e8 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-22T00:17:12Z |
| publishDate | 2021-05-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-fd2cdbc097b74957910a34a1d67900e82022-12-21T18:45:17ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362021-05-010906E971E97610.1055/a-1474-9932VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakageJonas Lange0Arno Dormann1Dirk Rolf Bulian2Ulrich Hügle3Claus Ferdinand Eisenberger4Markus Maria Heiss5Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, GermanyDepartment of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, GermanyDepartment of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, GermanyDepartment of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, GermanyDepartment of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, GermanyDepartment of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, GermanyBackground and study aims Endoscopic treatment has markedly improved the high morbidity and mortality in patients with upper gastrointestinal tract leakage. Most procedures employ either covered self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT), both with good clinical success but also with concomitant significant shortcomings inherent in each technique. A newly developed device, the VACStent, combines the fully covered SEMS with a polyurethane sponge cylinder anchored on the outside. This allows endoluminal EVT while keeping the intestinal lumen patent. The benefit is prevention of stent migration because the suction force of the sponge-cylinder immobilizes the VACStent on the intestinal wall, while at the same time, the attached external vacuum pump suctions off any secretions and improves healing with negative-pressure wound treatment (NPWT). Patients and methods In this pilot study, the first patients to receive the VACStent were assessed. Outcomes included the applicability and stability of the VACStent system together with the clinical course. Results Three patients with different clinical courses were managed with the VACStent. The first patient suffered anastomotic leakage following subtotal esophagectomy and was successfully treated with two postoperative VACStents for 12 days. The second patient received a covered SEMS for 14 days for acute Boerhaave syndrome. Due to persistent leakage, management was converted to EVT. Seven days, later a VACStent was inserted to allow oral nutrition while the leak finally closed. In the third patient, a LINX Reflux Management System had to be removed for erosion, leaving the gastroesophageal junction (GEJ) with a full-thickness gap. After VACstent insertion, successful closure was achieved within 4 days. Conclusions These clinical cases demonstrate the applicability and efficacy of the VACstent in management of esophageal and anastomotic leakage. With its vacuum sponge, the stent fosters wound healing while the covered SEMS keeps the passage patent for nutrition.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1474-9932 |
| spellingShingle | Jonas Lange Arno Dormann Dirk Rolf Bulian Ulrich Hügle Claus Ferdinand Eisenberger Markus Maria Heiss VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage Endoscopy International Open |
| title | VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage |
| title_full | VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage |
| title_fullStr | VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage |
| title_full_unstemmed | VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage |
| title_short | VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage |
| title_sort | vacstent combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1474-9932 |
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