The use of endoluminal vacuum (E-Vac) therapy in the management of upper XXXX and perforations.

@entity1 @entity344 @entity364 @entity1282 @entity204 @entity356
INTRODUCTION: Upper intestinal leaks and perforations are associated with high morbidity and mortality rates. Despite the growing experience using endoscopically placed stents, the treatment of these leaks and perforations remain a challenge. Endoluminal vacuum (E-Vac) therapy is a novel treatment that has been successfully used in Germany to treat upper @entity344 and perforations. There currently are no reports on its use in the USA. METHODS: E-Vac therapy was used to treat 11 @entity1 with upper @entity344 and perforations from September 2013 to September 2014. Five @entity1 with leaks following sleeve gastrectomy were excluded from this study. A total of six @entity1 were treated with E-Vac therapy; these included: (n  =  2) iatrogenic esophageal perforations, (n  =  1) iatrogenic esophageal and gastric perforations, (n  =  1) iatrogenic @entity356 , (n  =  1) gastric staple line leak following a surgical repair of a traumatic @entity356 , and (n  =  1) esophageal perforation due to an invasive @entity364 . Four @entity1 had failed an initial surgical repair prior to starting E-Vac therapy. RESULTS: All six @entity1 (100  %) had complete closure of their perforation or leak after an average of 35.8  days of E-Vac therapy requiring 7.2 different E-Vac changes. No @entity204 occurred in the 30  days following E-Vac therapy. One @entity1 died following complete closure of his perforation and transfer to an acute care facility due to an unrelated complication. There were no complications directly related to the use of E-Vac therapy. Only one @entity1 had any symptoms of @entity1282 . This @entity1 had severe @entity1282 from an esophagogastric anastomotic stricture prior to her iatrogenic perforations. Following E-Vac therapy, her @entity1282 had actually improved and she could now tolerate a soft diet. CONCLUSIONS: E-Vac therapy is a promising new method in the treatment of upper @entity344 and perforations. Current successes need to be validated through future prospective controlled studies.
