Modified endoscopic vacuum therapy for hypopharyngeal acute leakage after foreign body perforation

Conventional endoscopic vacuum therapy is currently used worldwide to treat esophageal leaks, with a healing rate of 67 %–100 % [1] [2]. The vacuum effect works through its effect on important mechanisms such as micro and macro deformation, tissue reperfusion, exudate control, and bacterial clearance [3]. Modified endoscopic vacuum therapy (MEVT) has some benefits when compared with the conventional technique, such as lower costs, less adherence, the requirement for fewer exchanges, and a shorter procedural duration [2]. In addition, it can be easily performed [4]. Although there were no reported cases of the use of hypopharyngeal vacuum therapy, we report a hypopharyngeal leak that was successfully treated with MEVT, leading to a new possibility when faced with hypopharyngeal defects.

A 42-year-old man came to the emergency room with progressive dysphagia 24 hours after eating food that included a piece of bone. A computed tomography (CT) scan detected a foreign body measuring 3.2 × 1.1 cm at the hypopharynx. Orotracheal intubation by bronchoscopy was indicated. Subsequently, the patient underwent endoscopic foreign body removal ([Fig. 1]); on reviewing the mucosa, we noted signs of perforation ([Fig. 2]). Therefore, MEVT was performed ([Fig. 3]; [Video 1]). The patient remained intubated for 5 days, during which time he received MEVT, antibiotics, and corticosteroids. After this period, a new bronchoscopy was performed, which demonstrated improvement of the edema of the hypopharynx, and the patient was extubated.

Fig. 1 Photograph of the foreign body, which was a piece of pork bone.

Fig. 2 Endoscopic view showing a hypopharyngeal perforation.

Fig. 3 Photograph of the modified endoscopic vacuum therapy device that was used.

Video 1 Endoscopy vacuum therapy is performed in the management of a hypopharyngeal leak caused by a perforation that was identified after endoscopic removal of a foreign body.

The patient progressively improved in terms of his clinical and laboratory parameters. He was evaluated by the otorhinolaryngology team after 8 days and a swallowing video-endoscopy was performed. This evaluation visualized complete velopharyngeal closure, the presence of salivary stasis, and preserved mobility, so his diet was upgraded to an oral homogeneous intake with a paste-like consistency. Endoscopic re-evaluation after 1 month demonstrated a white scar, with no signs of stenosis or other complications ([Fig. 4]). Outpatient follow-up demonstrated good tolerance of a regular diet, and the patient did not report any complaints.

Fig. 4 Endoscopic view showing a white scar after the leak had been successfully treated.

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Publication History

Article published online:
24 August 2022

• References

• 1 Virgilio E, Ceci D, Cavallini M. Surgical endoscopic vacuum-assisted closure therapy (EVAC) in treating anastomotic leakages after major resective surgery of esophageal and gastric cancer. Anticancer Res 2018; 38: 5581-5587
• 2 do Monte Junior ES, de Moura DTH, Ribeiro IB. et al. Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta-analysis. Dig Endosc 2021; 33: 892-902
• 3 de Moura DTH, de Moura BFBH, Manfredi MA. et al. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc 2019; 11: 329-344
• 4 de Moura DTH, Hirsch BS, do Monte Junior ES. et al. Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages. VideoGIE 2021; 6: 523-528