Management of upper gastro-intestinal leaks with endoscopic vaccum-Assisted closure system (e-vac): Two center experience.
Zaveri H, Surve A, Cottam D, Medlin W, Richards C, and Carlin A. Management of upper gastro-intestinal leaks with endoscopic vaccum-Assisted closure system (e-vac): Two center experience. Surg Obes Relat Dis 2017; 13(10):S22.
Surg Obes Relat Dis
Background: Gastrointestinal (GI) leak is a known complication after bariatric surgery. Although the incidence rate has decreased over the time, it is still the large concern for all the surgeons dealing with this complication in the post-operative period. Hence proper management, including endoscopic approach has become important. Endoscopic Vaccum-Assisted Closure System (E-VAC) is a new method based on negative pressure therapy used for the treatment of GI leaks in patients who are resistant to standard endoscopic and surgical treatment procedure. Currently, there is very limited data on the use of E-VAC to treat GI leaks. Objective: The purpose of this study was to show the effectiveness and clinical outcome of E-VAC therapy for the treatment of upper GI leaks. Methods: This is a retrospective study summarizes the experience of 2 bariatric centers using E-VAC therapy for patients with upper GI leaks between 2013 and 2017. The diagnosis and resolution of the leak was established with either an abdominal computed tomography (CT) scans, an upper gastrointestinal series (UGI) or esophagogastroduodenoscopy (EGD). The study demonstrated 6 patients who were treated with E-VAC therapy to resolve the leak. Results: Of 6 patients, 3 patients had staple line leak following sleeve gastrectomy (SG), 1 patient had leak from perforated Roux-en-Y gastric bypass (RYGB) ulcer, and 2 patients had gastroesophageal (GE) leak after Hiatal Hernia repair and SG surgery, respectively. Three patients had failed an initial surgical repair, use of esophageal metal stents as well as fibrin glue and CT guided drain along with esophageal stent respectively, before starting E-VAC therapy. All the patients were admitted with a mean of 75 days (1-460 days) after primary bariatric surgery. On an average, each patient received 4.3 procedures (includes placement and change of Endo- Sponge) for an average of 22 days (14-32 days). There were no complications directly related to the use of E-VAC therapy. Five of 6 patients had resolution of the leak, while 1 patient had the failure of resolution with E-VAC therapy and was changed to stent based therapy. Four patients were discharged and sent to the rehabilitation facility, 1 patient was discharged home, and 1 patient who had the failure of resolution was transferred to the University based hospital. No death was noted. Conclusions: E-VAC therapy can be used safely and effectively in patients with upper GI leaks. Further prospective controlled studies are required to validate these successes.