ENDOSCOPIC VACUUM THERAPY EFFECTIVENESS IN PATIENTS WITH ESOPHAGEAL FISTULAE

Aims Anastomotic leakage, esophageal wall perforation in Boerhaave syndrome or complications after endoscopic procedures are severe life threatening conditions and are not a very rare situation in clinical practice. Usage of endoscopic vacuum therapy (EVT) showed its effectiveness in treatment of esophageal defects of different origin. The aim of the study was to summarize our experience and to assess effectiveness of EVT in daily clinical practice in patients with esophageal fistulas including postoperative and postendoscopic leakages.

Methods 6 patients were treated with EVT from July 2018 to June 2019. Mean age was 54,7 (47–60), 4 men. Two patients with leaks after anastomosis placement, two patients with esophagopleural fistula, Boerhaave syndrome and two patients with complications after endoscopic manipulations were treated in Regional Clinical Hospital.

Results Mean time of EVT was 18,3 days (5–32), from 1 to 6 changes were done. In 5 patients vacuum therapy was effective. One patient with Boerhaave syndrome was operated due to the expended purulent process. Method shows its effectiveness in complications after endoscopic manipulations even in the case of esophageal mucosal fragments necrosis. Giant submucosal tumor was removed by tunnel method, tumor fragmentation was done because of the leiomyoma size (7*4 cm). On the third day after manipulation mucosal defect were found with contrast leakage to the mediastinum. 4 changes of vacuum system were necessary to heal the defects with percutaneous gastrostomy placement. No stenosis or any other complications were observed.

Conclusions EVT proved its effectiveness in case of not only Boerhaave syndrome but both in patients with postoperative leakages and with complications after endoscopic manipulation, even to prevent surgery with esophagectomy. Clinics with wide range of surgical procedures should have EVT as a complication management option.