Pull-through endoscopic vacuum-assisted closure therapy for complicated leaks of the gastrointestinal tract: Novel technique

Abstract

Background and study aims

Endoscopic vacuum-assisted closure (EVAC) of postsurgical leaks is an increasingly applied technique. Precise intracavitary sponge placement is technically challenging. Here, we describe a novel EVAC therapy using a combined external and endoluminal, pull-through technique.

Patients and methods

In this retrospective cohort study, we included all patients treated with pull-through EVAC for post-surgery leaks. During endoscopy, the proximal tip of the percutaneous drainage was visualized within the extraluminal abscess cavity, grasped with forceps, and pulled out orally while maintaining the distal end of the drainage above skin level. A foam sponge was fixed to the tip of the percutaneous drainage and sutured to a gastric tube at the other end. The sponge was placed in the cavity by pulling at the percutaneous drainage. Finally, the gastric probe was channeled nasally and suction was applied. Reinterventions comprised pulling the gastric tube, exchanging the sponge, and re-positioning, as described above. Therapy was stopped after closure or complete epithelialization of the leakage.

Results

Overall, seven patients were included between 2021 and 2023. Median duration of pull-through EVAC therapy was 30 days (interquartile range [IQR] 11–37 days) and the median number of endoscopic interventions was six (IQR 4–10). Technical and clinical success was achieved in all (100%) and in six of seven patients (85.7%), respectively. In total, one major bleeding complication associated with EVAC therapy occurred (14.3%).

Conclusions

Pull-through EVAC therapy is safe and effective in patients with large and challenging postsurgical leaks of the upper gastrointestinal tract.

Keywords

Endoscopy Small Bowel - Small bowel endoscopy - Quality and logistical aspects - Performance and complications - GI surgery

Publication History

Received: 11 April 2024

Accepted after revision: 23 September 2024

Accepted Manuscript online:
25 October 2024

Article published online:
30 January 2025

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