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. 2015 Dec;3(6):E547-51.
doi: 10.1055/s-0034-1392566. Epub 2015 Aug 3.

Iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT)

Gunnar Loske  1 , Tobias Schorsch  1 , Christian Dahm  1 , Eckhard Martens  2 , Christian Müller  1
Affiliations

Iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT)

Gunnar Loske et al. Endosc Int Open. 2015 Dec.

Abstract

Background and study aims: Endoscopic Vacuum Therapy (EVT) has been reported as a novel treatment option for esophageal leakage. We present our results in the treatment of iatrogenic perforation with EVT in a case series of 10 patients.

Patients and methods: An open pore polyurethane drainage was placed either intracavitary through the perforation defect or intraluminal covering the defect zone. Application of vacuum suction with an electronic device (continuous negative pressure, -125 mmHg) resulted in defect closure and internal drainage.

Results: Esophageal perforations were located from the cricopharyngeus (4/10) to the esophagogastric junction (2/10). EVT was feasible in all patients. Eight patients were treated with intraluminal EVT, one with intracavitary EVT, and one with both types of treatments. All perforations (100 %) were healed in within a median of (3 - 7) days. No stenosis occurred, no complications were observed, and no additional operative treatment was necessary.

Conclusions: Our study suggests that intraluminal EVT will play an important role in endoscopic management of esophageal perforation.

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Conflict of interest statement

Competing interests: Gunnar Loske is a consultant for Lohmann & Rauscher GmbH & Co. KG. Tobias Schorsch, Christian Dahm, Eckhard Martens and Christian Müller declare that no conflict of interest exists.

Figures

Fig. 1 a
Fig. 1 a
Open pore polyurethane foam (PU) fixed at tip of drainage tube (T), endoscope (E), grasper (G), b Open pore drainage. Left: short polyurethane foam (PU) for intracavitary EVT; right: long PU for intraluminal EVT; endoscope (E); drainage tube (T).
Fig. 2 a
Fig. 2 a
Esophageal placement of open pore drainage (polyurethane foam [PU], suture [S], drainage tube [T], grasper [G]. b After 2 days of intracavitary EVT (wound edges [We] of perforation defect). c After 3 days of intraluminal EVT (wound edges [We] stick together). d 8 days after a 5-day treatment with EVT (erosion pattern has disappeared and a tiny scar [Sc] is the residuum of the perforation defect [esophageal Lumen {L}]).
Fig. 3
Fig. 3
Schematic for intraluminal EVT. a Open pore foam drainage has been inserted into the esophageal lumen. b After application of vacuum suction, the esophageal lumen collapses around and with the open pore foam.
See this image and copyright information in PMC

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