TY  - JOUR
T1  - Endoluminal Vacuum Therapy Using a New “Fistula Sponge” In Small Defects of the Upper Gastrointestinal Tract – A Comparative, Single Center Study
T2  - Endoscopy
T5  - Oral presentation at ESGE Days 2021
LA  - English
AU  - Ellrichmann, M.
AU  - Hoffmann, J.
AU  - Kataev, V.
AU  - Richter, F.
AU  - Egberts, J. H.
AU  - Schreiber, S.
AU  - Becker, T.
AU  - Schoenfels, W.
AU  - Reichert, B.
AB  - Aims Anastomotic insufficiencies(AI) and perforations of the upper gastrointestinal tract(uGIT) result in high morbidity and mortality. Besides surgical revision and endoscopic stent placement the endoluminal vacuum therapy(EVT) has been established as an additional strategy. So far, the Eso-Sponge is the only licensed EVT system with limitations in very small defects. Therefore, a fistula sponge(FS) was established in our center for the treatment of small defects of the uGIT as a new therapeutic approach. To evaluate success rates, indications and complications of both EVT options in a retrospective, single-center trial.

Methods Between 01/2018 and 12/2020 all patients undergoing either a FS-EVT or conventional EVT(cEVT) with Eso-Sponge (Braun Melsungen, Germany) due to AI or perforation of the uGIT were recorded. Following criteria were evaluated: indication, diameter of leakage, therapy success and complications. FSs were prepared using a nasogastric tube (6-16Ch diameter) and a porous drainage film (Suprasorb CNP, Lohmann&Rauscher, Germany)(length 1 – 6 cm) sutured to the distal tip.

Results N = 72 patients were included in this analysis (FS-EVT N = 20; cEVT N = 52). FS-EVT was performed in 60 % suffering from AI (cEVT = 68 %) and 40 % from perforation (cEVT = 32 %;p>0.05). After 6.2±3.3d of treatment FSs were exchanged every three days in average, comparable data were obtained for cEVT. The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT(p < 0.001), the depth of the leakage showed no significant difference (46 mm for both groups). Therapeutic success (development of granulation tissue, resolution of the leak) was achieved in 90 % (FS-EVT) and 91 % (cEVT) respectively (p > 0.05).

Conclusions EVT comprises an extraordinary treatment option of transmural defects of the uGIT. In clinical practice fistulas <10 mm with large abscess formations exhibit a special challenge, since intraluminal cEVT normally fails. In these cases the concept of extraluminal FS placement is safe and effective.
DO  - 10.1055/s-0041-1724357
IS  - 53
PY  - 2021
SP  - 42
JF  - Endoscopy
ER  -