Endoscopic negative pressure therapy (ENPT) for duodenal leakage – novel repair technique using open-pore film (OFD) and polyurethane-foam drainages (OPD)

Gunnar Loske; Frank Rucktaeschel; Tobias Schorsch; Klaus Moenkemueller; Christian Theodor Mueller

doi:10.1055/a-0972-9660

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1424-E1431
DOI: 10.1055/a-0972-9660

Original article

Endoscopic negative pressure therapy (ENPT) for duodenal leakage – novel repair technique using open-pore film (OFD) and polyurethane-foam drainages (OPD)

Authors

Gunnar Loske

¹Marienkrankenhaus - Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany, Hamburg
Frank Rucktaeschel

²Westküstenklinikum Heide - Department for Internal Medicine, Gastroenterology, Hemato-Oncology, Nephrology and Endocrinology, Heide, Schleswig-Holstein, Germany
Tobias Schorsch

¹Marienkrankenhaus - Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany, Hamburg
Klaus Moenkemueller

³HELIOS Frankenwaldklinik Kronach - Department of Gastroenterology
Kronach, Bayern, Germany
Christian Theodor Mueller

¹Marienkrankenhaus - Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany, Hamburg

Abstract

Background and study aims Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages.

Patients and methods The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of –125 mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days.

Results Eleven patients were treated with duodenal leaks. Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth – 1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 – 24 days). Complete healing of defects was achieved in all patients.

Conclusion ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects.

Full Text

References

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