Research progress of endoscopic vacuum-assisted closure therapy for esophageal fistulas_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIE Hongxin ^1,2 , LIU Honggang ³ , WANG Bing ¹ , DU Jinchen ² , ZHANG Bin ² ,  MENG Hui ³

1. Department of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;
2. Department of Cardiothoracic Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730000, P.R.China;
3. Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, 519100, Guangdong, P.R.China;

Corresponding author：

MENG Hui, Email: mhgl2008@163.com

Keywords：

Esophageal fistula; endoscopic vacuum-assisted closure therapy; minimally invasive therapy; review

DOI：

10.7507/1007-4848.202007013

Video：

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How to effectively repair esophageal fistulas, caused by esophageal perforation, rupture and anastomotic leakage after esophagectomy has always been a key problem for the digestive surgeon. Although there are many clinical treatment methods, the therapeutic effect is still completely unsatisfactory, especially when severe mediastinal purulent cavity infection is associated with the esophageal fistula. In recent years, foreign centers have promoted a new minimally invasive endoscopic treatment technology to repair the esophageal fistula, endoscopic vacuum-assisted closure therapy, with significantly curative effect. In this article, we will review the specific operation, advantages and disadvantages, as well as the clinical efficacy of endoscopic vacuum-assisted closure therapy in treating the esophageal fistulas, to provide a new therapeutic technique for esophageal fistulas and expand the new field of minimally invasive endoscopic therapy.

Citation： NIE Hongxin, LIU Honggang, WANG Bing, DU Jinchen, ZHANG Bin, MENG Hui. Research progress of endoscopic vacuum-assisted closure therapy for esophageal fistulas. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1381-1387. doi: 10.7507/1007-4848.202007013 Copy

1.	赵珩, 高文, 曹克坚, 等, 主编. 胸外科手术学. 北京: 人民卫生出版社, 2017. 754-757.
2.	Di Leo M, Maselli R, Ferrara EC, et al. Endoscopic management of benign esophageal ruptures and leaks. Curr Treat Options Gastroenterol, 2017, 15(2): 268-284.
3.	Verstegen MHP, Bouwense SAW, van Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: A systematic review. World J Emerg Surg, 2019, 14: 17.
4.	徐义军, 张文杰. 消化道吻合口瘘内镜微创治疗的现状及进展. 中国普通外科杂志, 2019, 28(4): 491-497.
5.	Watson A, Zuchelli T. Repair of upper-GI fistulas and anastomotic leakage by the use of endoluminal vacuum-assisted closure. VideoGIE, 2019, 4(1): 40-44.
6.	Rausa E, Asti E, Aiolfi A, et al. Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: Systematic review and meta-analysis. Dis Esophagus, 2018, 31(11): 1-8.
7.	Mennigen R, Senninger N, Laukoetter MG. Endoscopic vacuum therapy of esophageal anastomotic leakage. Gastrointest Endosc, 2015, 82(2): 397.
8.	Youn HC, Kwon SH. Endoscopic vacuum-assisted closure (E-VAC) treatment in a patient with delayed anastomotic perforation following a perforated gastric conduit repair after an Ivor-Lewis esophagectomy. Ann Thorac Cardiovasc Surg, 2016, 22(6): 363-366.
9.	Struyve M, De Vloo C, Van Veer H, et al. Endoscopic vacuum-assisted closure therapy for the treatment of oesophageal anastomotic leaks. Acta Gastroenterol Belg, 2019, 82(4): 529-531.
10.	Weidenhagen R, Gruetzner KU, Wiecken T, et al. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: A new method. Surg Endosc, 2008, 22(8): 1818-1825.
11.	Wedemeyer J, Schneider A, Manns MP, et al. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc, 2008, 67(4): 708-711.
12.	Brangewitz M, Voigtländer T, Helfritz FA, et al. Endoscopic closure of esophageal intrathoracic leaks: Stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy, 2013, 45(6): 433-438.
13.	Ooi G, Burton P, Packiyanathan A, et al. Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. ANZ J Surg, 2018, 88(4): E257-E263.
14.	Ward MA, Hassan T, Burdick JS, et al. Endoscopic vacuum assisted wound closure (EVAC) device to treat esophageal and gastric leaks: Assessing time to proficiency and cost. Surg Endosc, 2019, 33(12): 3970-3975.
15.	Loske G, Schorsch T, Müller C. Intraluminal and intracavitary vacuum therapy for esophageal leakage: A new endoscopic minimally invasive approach. Endoscopy, 2011, 43(6): 540-544.
16.	de Moura DTH, de Moura BFBH, Manfredi MA, et al. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc, 2019, 11(5): 329-344.
17.	Kuehn F, Loske G, Schiffmann L, et al. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc, 2017, 31(9): 3449-3458.
18.	Starkov YG, Vybornyi MI, Ruchkin DV, et al. Endoscopic treatment of esophageal anastomotic leakage using vacuum-assisted closure system. Khirurgiia (Mosk), 2019, 10: 13-20.
19.	Cwaliński J, Hermann J, Kasprzyk M, et al. Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report. World J Gastrointest Endosc, 2020, 12(1): 42-48.
20.	Min YW, Kim T, Lee H, et al. Endoscopic vacuum therapy for postoperative esophageal leak. BMC Surg, 2019, 19(1): 37.
21.	Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg, 1997, 38(6): 553-562.
22.	Argenta LC, Morykwas MJ. Vacuum-assisted closure: A new method for wound control and treatment: Clinical experience. Ann Plast Surg, 1997, 38(6): 563-576.
23.	Jung CFM, Müller-Dornieden A, Gaedcke J, et al. Impact of endoscopic vacuum therapy with low negative pressure for esophageal perforations and postoperative anastomotic esophageal leaks. Digestion, 2021, 102(3): 469-479.
24.	Mandarino FV, Bonura GF, Esposito D, et al. A large anastomotic leakage after esophageal surgery treated with endoluminal vacuum-assisted closure: A case report. J Surg Case Rep, 2020, 2020(4): rjaa071.
25.	Watkins JR, Farivar AS. Endoluminal therapies for esophageal perforations and leaks. Thorac Surg Clin, 2018, 28(4): 541-554.
26.	Mennigen R, Harting C, Lindner K, et al. Comparison of endoscopic vacuum therapy versus stent for anastomotic leak after esophagectomy. J Gastrointest Surg, 2015, 19(7): 1229-1235.
27.	Pines G, Bar I, Elami A, et al. Modified endoscopic vacuum therapy for nonhealing esophageal anastomotic leak: Technique description and review of literature. J Laparoendosc Adv Surg Tech A, 2018, 28(1): 33-40.
28.	Mencio MA, Ontiveros E, Burdick JS, et al. Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: A single institution experience. Surg Endosc, 2018, 32(7): 3349-3356.
29.	Virgilio E, Ceci D, Cavallini M. Surgical endoscopic vacuum-assisted closure therapy (EVAC) in treating anastomotic leakages after major resective surgery of esophageal and gastric cancer. Anticancer Res, 2018, 38(10): 5581-5587.
30.	Schorsch T, Müller C, Loske G. Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc, 2013, 27(6): 2040-2045.
31.	Kuehn F, Schiffmann L, Janisch F, et al. Surgical endoscopic vacuum therapy for defects of the upper gastrointestinal tract. J Gastrointest Surg, 2016, 20(2): 237-243.
32.	Bludau M, Fuchs HF, Herbold T, et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc, 2018, 32(4): 1906-1914.
33.	Laukoetter MG, Mennigen R, Neumann PA, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): A prospective cohort study. Surg Endosc, 2017, 31(6): 2687-2696.
34.	Gubler C, Schneider PM, Bauerfeind P. Complex anastomotic leaks following esophageal resections: The new stent over sponge (SOS) approach. Dis Esophagus, 2013, 26(6): 598-602.
35.	Dhayat SA, Schacht R, Mennigen R, et al. Long-term quality of life assessment after successful endoscopic vacuum therapy of defects in the upper gastrointestinal tract quality of life after EVT. J Gastrointest Surg, 2019, 23(2): 280-287.
36.	Thompson SK, Watson DI. We asked the experts: "To stent or not to stent… What is the best management of an esophageal leak or benign perforation?" World J Surg, 2020, 44(4): 1190-1191.
37.	Hwang JJ, Jeong YS, Park YS, et al. Comparison of endoscopic vacuum therapy and endoscopic stent implantation with self-expandable metal stent in treating postsurgical gastroesophageal leakage. Medicine (Baltimore), 2016, 95(16): e3416.
38.	Berlth F, Bludau M, Plum PS, et al. Self-expanding metal stents versus endoscopic vacuum therapy in anastomotic leak treatment after oncologic gastroesophageal surgery. J Gastrointest Surg, 2019, 23(1): 67-75.
39.	Scognamiglio P, Reeh M, Karstens K, et al. Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: Systematic review and meta-analysis. Endoscopy, 2020, 52(8): 632-642.
40.	Leeds SG, Burdick JS, Fleshman JW. Endoluminal vacuum therapy for esophageal and upper intestinal anastomotic leaks. JAMA Surg, 2016, 151(6): 573-574.
41.	Walsh LT, Loloi J, Manzo CE, et al. Successful treatment of large cavity esophageal disruptions with transluminal washout and endoscopic vacuum therapy: A report of two cases. Ther Adv Gastrointest Endosc, 2019, 12: 1-6.
42.	Newton NJ, Sharrock A, Rickard R, et al. Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations. Dis Esophagus, 2017, 30(3): 1-5.
43.	Baltin C, Kron F, Urbanski A, et al. The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy. PLoS One, 2019, 14(8): e0221406.
44.	Smallwood NR, Fleshman JW, Leeds SG, et al. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc, 2016, 30(6): 2473-2480.
45.	Endara SA, Terán FJ, Serrano AJ, et al. Esophagocoloplasty fistula successfully treated with vacuum-assisted closure. J Surg Case Rep, 2018, 2018(1): rjx256.

1. 赵珩, 高文, 曹克坚, 等, 主编. 胸外科手术学. 北京: 人民卫生出版社, 2017. 754-757.
2. Di Leo M, Maselli R, Ferrara EC, et al. Endoscopic management of benign esophageal ruptures and leaks. Curr Treat Options Gastroenterol, 2017, 15(2): 268-284.
3. Verstegen MHP, Bouwense SAW, van Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: A systematic review. World J Emerg Surg, 2019, 14: 17.
4. 徐义军, 张文杰. 消化道吻合口瘘内镜微创治疗的现状及进展. 中国普通外科杂志, 2019, 28(4): 491-497.
5. Watson A, Zuchelli T. Repair of upper-GI fistulas and anastomotic leakage by the use of endoluminal vacuum-assisted closure. VideoGIE, 2019, 4(1): 40-44.
6. Rausa E, Asti E, Aiolfi A, et al. Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: Systematic review and meta-analysis. Dis Esophagus, 2018, 31(11): 1-8.
7. Mennigen R, Senninger N, Laukoetter MG. Endoscopic vacuum therapy of esophageal anastomotic leakage. Gastrointest Endosc, 2015, 82(2): 397.
8. Youn HC, Kwon SH. Endoscopic vacuum-assisted closure (E-VAC) treatment in a patient with delayed anastomotic perforation following a perforated gastric conduit repair after an Ivor-Lewis esophagectomy. Ann Thorac Cardiovasc Surg, 2016, 22(6): 363-366.
9. Struyve M, De Vloo C, Van Veer H, et al. Endoscopic vacuum-assisted closure therapy for the treatment of oesophageal anastomotic leaks. Acta Gastroenterol Belg, 2019, 82(4): 529-531.
10. Weidenhagen R, Gruetzner KU, Wiecken T, et al. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: A new method. Surg Endosc, 2008, 22(8): 1818-1825.
11. Wedemeyer J, Schneider A, Manns MP, et al. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc, 2008, 67(4): 708-711.
12. Brangewitz M, Voigtländer T, Helfritz FA, et al. Endoscopic closure of esophageal intrathoracic leaks: Stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy, 2013, 45(6): 433-438.
13. Ooi G, Burton P, Packiyanathan A, et al. Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. ANZ J Surg, 2018, 88(4): E257-E263.
14. Ward MA, Hassan T, Burdick JS, et al. Endoscopic vacuum assisted wound closure (EVAC) device to treat esophageal and gastric leaks: Assessing time to proficiency and cost. Surg Endosc, 2019, 33(12): 3970-3975.
15. Loske G, Schorsch T, Müller C. Intraluminal and intracavitary vacuum therapy for esophageal leakage: A new endoscopic minimally invasive approach. Endoscopy, 2011, 43(6): 540-544.
16. de Moura DTH, de Moura BFBH, Manfredi MA, et al. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc, 2019, 11(5): 329-344.
17. Kuehn F, Loske G, Schiffmann L, et al. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc, 2017, 31(9): 3449-3458.
18. Starkov YG, Vybornyi MI, Ruchkin DV, et al. Endoscopic treatment of esophageal anastomotic leakage using vacuum-assisted closure system. Khirurgiia (Mosk), 2019, 10: 13-20.
19. Cwaliński J, Hermann J, Kasprzyk M, et al. Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report. World J Gastrointest Endosc, 2020, 12(1): 42-48.
20. Min YW, Kim T, Lee H, et al. Endoscopic vacuum therapy for postoperative esophageal leak. BMC Surg, 2019, 19(1): 37.
21. Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg, 1997, 38(6): 553-562.
22. Argenta LC, Morykwas MJ. Vacuum-assisted closure: A new method for wound control and treatment: Clinical experience. Ann Plast Surg, 1997, 38(6): 563-576.
23. Jung CFM, Müller-Dornieden A, Gaedcke J, et al. Impact of endoscopic vacuum therapy with low negative pressure for esophageal perforations and postoperative anastomotic esophageal leaks. Digestion, 2021, 102(3): 469-479.
24. Mandarino FV, Bonura GF, Esposito D, et al. A large anastomotic leakage after esophageal surgery treated with endoluminal vacuum-assisted closure: A case report. J Surg Case Rep, 2020, 2020(4): rjaa071.
25. Watkins JR, Farivar AS. Endoluminal therapies for esophageal perforations and leaks. Thorac Surg Clin, 2018, 28(4): 541-554.
26. Mennigen R, Harting C, Lindner K, et al. Comparison of endoscopic vacuum therapy versus stent for anastomotic leak after esophagectomy. J Gastrointest Surg, 2015, 19(7): 1229-1235.
27. Pines G, Bar I, Elami A, et al. Modified endoscopic vacuum therapy for nonhealing esophageal anastomotic leak: Technique description and review of literature. J Laparoendosc Adv Surg Tech A, 2018, 28(1): 33-40.
28. Mencio MA, Ontiveros E, Burdick JS, et al. Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: A single institution experience. Surg Endosc, 2018, 32(7): 3349-3356.
29. Virgilio E, Ceci D, Cavallini M. Surgical endoscopic vacuum-assisted closure therapy (EVAC) in treating anastomotic leakages after major resective surgery of esophageal and gastric cancer. Anticancer Res, 2018, 38(10): 5581-5587.
30. Schorsch T, Müller C, Loske G. Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc, 2013, 27(6): 2040-2045.
31. Kuehn F, Schiffmann L, Janisch F, et al. Surgical endoscopic vacuum therapy for defects of the upper gastrointestinal tract. J Gastrointest Surg, 2016, 20(2): 237-243.
32. Bludau M, Fuchs HF, Herbold T, et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc, 2018, 32(4): 1906-1914.
33. Laukoetter MG, Mennigen R, Neumann PA, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): A prospective cohort study. Surg Endosc, 2017, 31(6): 2687-2696.
34. Gubler C, Schneider PM, Bauerfeind P. Complex anastomotic leaks following esophageal resections: The new stent over sponge (SOS) approach. Dis Esophagus, 2013, 26(6): 598-602.
35. Dhayat SA, Schacht R, Mennigen R, et al. Long-term quality of life assessment after successful endoscopic vacuum therapy of defects in the upper gastrointestinal tract quality of life after EVT. J Gastrointest Surg, 2019, 23(2): 280-287.
36. Thompson SK, Watson DI. We asked the experts: "To stent or not to stent… What is the best management of an esophageal leak or benign perforation?" World J Surg, 2020, 44(4): 1190-1191.
37. Hwang JJ, Jeong YS, Park YS, et al. Comparison of endoscopic vacuum therapy and endoscopic stent implantation with self-expandable metal stent in treating postsurgical gastroesophageal leakage. Medicine (Baltimore), 2016, 95(16): e3416.
38. Berlth F, Bludau M, Plum PS, et al. Self-expanding metal stents versus endoscopic vacuum therapy in anastomotic leak treatment after oncologic gastroesophageal surgery. J Gastrointest Surg, 2019, 23(1): 67-75.
39. Scognamiglio P, Reeh M, Karstens K, et al. Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: Systematic review and meta-analysis. Endoscopy, 2020, 52(8): 632-642.
40. Leeds SG, Burdick JS, Fleshman JW. Endoluminal vacuum therapy for esophageal and upper intestinal anastomotic leaks. JAMA Surg, 2016, 151(6): 573-574.
41. Walsh LT, Loloi J, Manzo CE, et al. Successful treatment of large cavity esophageal disruptions with transluminal washout and endoscopic vacuum therapy: A report of two cases. Ther Adv Gastrointest Endosc, 2019, 12: 1-6.
42. Newton NJ, Sharrock A, Rickard R, et al. Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations. Dis Esophagus, 2017, 30(3): 1-5.
43. Baltin C, Kron F, Urbanski A, et al. The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy. PLoS One, 2019, 14(8): e0221406.
44. Smallwood NR, Fleshman JW, Leeds SG, et al. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc, 2016, 30(6): 2473-2480.
45. Endara SA, Terán FJ, Serrano AJ, et al. Esophagocoloplasty fistula successfully treated with vacuum-assisted closure. J Surg Case Rep, 2018, 2018(1): rjx256.

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