ENDOSCOPIC VACUUM-ASSISTED CLOSURE SYSTEM (E-VAC) FOR THE TREATMENT OF UPPER GASTRO-INTESTINAL ANASTOMOTIC LEAKAGES: REPORT OF TWO CASES

Aims:

Treatment of digestive anastomotic leakages remains challenging and there are no specific recommendations of care. Recently, endoscopic vacuum-assisted closure system (E-VAC) was developed and used to treat intestinal leakage not responding to standard treatment. This technique provides wound drainage, promotes tissue granulation and closure of the fistula. Data come from cases reports or small series suggesting that (E-VAC) is a safe and effective procedure.

Methods:

We report here two cases of upper gastro-intestinal anastomotic leakages treated by E-VAC. The endoscopic procedures were performed under general anesthesia with intubation. After an endoscopic assessment of the leak and the cavity, the size of the polyurethane sponge was adjusted. The sponge was introduced into the cavity through the luminal defect with a gastroscope. A negative pressure was applied constantly to the sponge and the E-VAC was changed every week.

Results:

We treated with E-VAC, leakage of one esophago-jejunal and one gastroduodenal anastomosis. Both were complicated by liquid collections. Sponges were changed two and three times respectively and time interval between each change of sponge was between 5 and 7 days. No complications were observed during the treatment with E-VAC. This procedure closed both leaks after three weeks of treatment. No reopening of the fistulas was observed after more than 6 months of follow-up.

Conclusions:

E-VAC should be considered as an effective and safe treatment of upper gastro-intestinal anastomotic leakages. This procedure requires a multidisciplinary approach and has to be compared to standard care in larger and controlled studies.