Subscribe to RSS

DOI: 10.1055/a-1948-1816
Transabdominal esophago-cutaneous fistula closure with endoscopic negative pressure therapy using a thin open-pore film drain in a pull-through technique

A 77-year-old patient underwent gastrectomy for AEG III (G3, pT3, pN0). The postoperative course was complicated by insufficiency of the esophageal-jejunal anastomosis. Endoscopic treatments with endoscopic negative pressure therapy (ENPT), clips, and stenting did not result in a final defect closure. A long transabdominal esophago-cutaneous fistula persisted. The patient was transferred to us 4 weeks after surgery, with the surgical drain and a stent still in place.
The stent was removed. The surgical drain was seen through the anastomotic defect, which was approximately 1 cm in diameter. With a small endoscope, a 30-cm transabdominal fistula channel was examined from the anastomotic defect to the cutaneous opening ([Fig. 1]). The surgical drain was removed.


Using the endoscope, an open-pore film drainage (OFD) (with a 25-cm open-pore film drainage element in the middle section, diameter 6 mm) ([Fig. 2]) was pulled from the cutaneous opening into the fistula tract using the pull-through technique [1] [2] [3] [4] [5] ([Video 1], [Fig. 2]).


Video 1 The video demonstrates the course of therapy and the pull-through method of placing the open-pore film drainage (OFD). The video image shows the cutting of a strip of the thin open-pore film to make the OFD.
Quality:
In OFDs, a thin, open-pore, double-layered membrane (Suprasorb CNP Drainage Film; Lohmann & Rauscher, Rengsdorf, Germany) is wrapped around a drainage tube as a drainage element ([Fig. 3]).


The drainage element was placed in the fistula channel; the oral end of the element overlapped the esophageal defect by 1 cm. The cutaneous end of the OFD was closed with a clamp. The oral end was led out nasally and connected to an electronic pump (ACTIV.A.C; KCI, San Antonio, Texas, USA). Continuous negative pressure of –125 mmHg was applied. Secretion through the fistula stopped immediately. Fluoroscopy confirmed adequate fistula closure ([Fig. 4]).


After 4 days, the OFD was exchanged for a thinner OFD (4 mm in diameter, 25 cm drainage element) again using the pull-through technique. The collapsed fistula channel was completely lined with a typical regular suction pattern along its entire length ([Fig. 5]).


After a total of 10 days ENPT ended. The patient was allowed to drink water. On the following day, radiological contrast examination confirmed fistula closure and patient started with a soft diet. Endoscopy showed the healed leak without stenosis during further follow-up.
Endoscopy_UCTN_Code_CPL_1AH_2AG
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
Publication History
Article published online:
28 October 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Loske G, Schorsch T, Rucktaeschel F. et al. Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT). Endosc Int Open 2018; 6: E865-E871
- 2 Loske G, Liedke M, Schlöricke E. et al. Endoscopic negative pressure therapy for duodenal leakage using new open-pore film and polyurethane foam drains with the pull-through technique. Endoscopy 2017; 49: E300-E302
- 3 Rucktaeschel F, Liedtke M, Schlöricke E. et al. Gastroduodenal anastomotic insufficiency: pull-through technique for endoscopic negative pressure therapy with new types of open-pore drains. Endoscopy 2019; 51: E85-E87
- 4 Loske G, Müller J, Röske A. et al. Closure of a duodenal cutaneous fistula with endoscopic negative pressure therapy using a thin open-pore film drain – an easy tool and simple method. Endoscopy 2021; DOI: 10.1055/a-1638-8725. Epub ahead of print
- 5 Loske G, Müller CT. Tips and tricks for endoscopic negative pressure therapy. Chirurg 2019; 90: 7-14