Anastomotic leakage (AL) is a pervasive and risky postoperative complication that presently features inaccessible prevention, delayed diagnosis, and intractable remediation, resulting in distressing morbidity and mortality. Herein an interior/exterior collaboration-enhanced neoteric intestinal anastomosis (IECIA) is developed, which consists of an interior hydrogel-based protective barrier adhering to mucosa, and exterior synergistic leakage-prevention safeguard sutured to serosa, for multi-tiered leakage complication management. Noticeably, the hydrogel barrier protects anastomosis stoma against injurious stimulation from digestive liquid, consequently reducing leakage risk effectively and comfortably in place of painful gastric tube insertion. The exterior safeguard encompassing fluorescein-loaded hydrogel and electrospun film functions as a secondary defense, exhibiting critical leakage-prevention capability to refrain from lethal intra-abdominal infection. Meanwhile, fluorescein is released to the enteric cavity for following detection within the excrement in case anastomotic leakage occurs, achieving presymptomatic alarming in providing valuable prompts for timely clinical intervention. Importantly, IECIA has been investigated in realistic in vivo end-to-end intestinal anastomosis scenarios as well as simulated leakage models, which present satisfactory postoperative recovery of gastrointestinal functions and systematic indexes. Moreover, the IECIA system is endowed with guaranteed biocompatibility, effective durability, comprehensibility for surgical operation, comfort, and compliance for patients, which demonstrates precious value for clinical translation.

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 first-line 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.

Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.

Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.

Endoscopic vacuum treatment (EVT) is increasingly used in the treatment of anastomotic leakages and perforations in the upper gastrointestinal tract. However, sponges often have to be mounted individually on a gastric tube and endoscopic introduction of the latter into an infected extraluminal cavity is challenging. In order to facilitate this procedure in some anatomical situations, we developed the prototype of a new sponge for EVT called a two-side sponge (TSS).

Injuries to the esophageal wall, such as perforations and anastomotic leaks, are serious complications of surgical and endoscopic interventions. Since 2006, a new treatment has been introduced, in the form of endoscopically placed vacuum sponge therapy.

Between April 2012 and October 2014, 10 patients (5 men and 5 women) aged 57 to 94 years were treated at our institution using endoscopic vacuum therapy (EVT) in the upper gastrointestinal tract.

The defect in the esophageal wall was successfully closed in seven of the 10 patients (70 %). No severe complications occurred.

EVT is a valuable tool for management of defects in the esophageal wall and should be considered as a treatment option for patients with this condition.