Post written by Rami Archid, MD, from the Department of General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Tuebingen, Germany.
A 61-year-old male patient was treated for Siewert type I gastroesophageal junction adenocarcinoma. Neoadjuvant chemotherapy using FLOT regimen (5-fluorouracil, leucovorin, oxaliplatin, docetaxel) with Trastuzumab was followed by esophagectomy with cervical esophagogastrostomy. On postoperative day 3, he became septic. Bedside endoscopy showed a compromised anastomosis without obvious leakage. Endoscopic intraluminal negative pressure therapy using a fashioned open-pore film drainage (OFD) was performed to promote healing of the anastomosis. Repeat endoscopy 10 days after the procedure showed significant improvement.
Endoscopic negative pressure therapy (ENPT) represents a modern and effective treatment strategy for gastrointestinal tract wall defects. The intracavitary treatment strategy is based on the placement of a sponge within the defect cavity. However, in many clinical situations we have a small leak cavity or a compromised anastomosis without a manifest leak Accordingly, intracavitary placement of a negative pressure device might be difficult and requires enlargement of leaks for positioning of device. The presented fashioned OFD is designed especially for intraluminal ENPT. It offers several advantages in terms of easier placement, less adhesiveness to the wound bed, decreased need for reintervention, better fluids mobilization, and easy removal. Furthermore, it allows simultaneous enteral feeding.
We present new insights on endoscopic treatment of gastrointestinal tract wall defects with active drainage using ENPT. Details of the treatment algorithm at our department, the manual assembly of an OFD device, and the performance of the endoscopic procedure are presented in detail.
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