Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects

• 作者: Ahmad N Bazarbashi Bruna Furia Buzetti Hourneaux de Moura Christopher C Thompson Diogo Turiani Hourneaux de Moura Eduardo Guimaraes Hourneaux de Moura Igor Braga Ribeiro Kelly E Hathorn Michael A Manfredi
• 来源期刊: 世界胃肠内镜杂志:英文版(电子版)
• 学科: 医学
• 关键词: GASTROINTESTINAL Endoscopy ENDOSCOPIC vacuum THERAPY Negative pressure THERAPY FISTULA LEAK PERFORATION Defect
• 年，卷（期）: 2019,（5）
• 页码范围: 329-344
• 页数: 16页
• 分类号: R

摘要

A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a firstline approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects.