Current Status of Endoscopic Vacuum Therapy in the Management of Esophageal Perforations and Post-Operative Leaks
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Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and posea significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopicvacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of apolyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention ofpromoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasinglyadopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growingbody of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupledwith the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has becomeincreasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications,technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight futuredirections for the use of EVT in esophageal wall defects.
Abstract
Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and posea significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopicvacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of apolyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention ofpromoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasinglyadopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growingbody of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupledwith the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has becomeincreasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications,technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight futuredirections for the use of EVT in esophageal wall defects.
참고문헌 (40)
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