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

Abstract

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.

Keywords: Gastrointestinal; Endoscopy; Endoscopic vacuum therapy; Negative pressure therapy; Fistula; Leak; Perforation; Defect

Core tip: Gastrointestinal (GI) transmural defects, including perforations, leaks, and fistulas, are difficult to manage and are associated with high rates of morbidity and mortality. Endoscopic vacuum therapy (EVT) has developed into a valuable tool for the treatment of these conditions. EVT has proven to be an effective and safe method in the intraluminal treatment of transmural defects, as it promotes changes in perfusion, causes microdeformation and macrodeformation, and decreases bacterial contamination, secretion, and local edema to facilitate healing. In this review, we discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with transmural GI defects.