Endoscopic vacuum-assisted closure therapy for leakage of the lower gastrointestinal tract: multicenter experiences

• Published in: Endoscopy International Open 2023-02, Vol.11 (2), p.E212-E217
• Main Authors: Book, Thorsten, Engelke, Carsten, Brüggerhoff, Raphael, Winny, Markus, Kraus, Martin, Benecke, Claudia, Zimmermann, Markus, Trostdorf, Ulf, Wedemeyer, Heiner, Marquardt, Jens U., Voigtländer, Torsten, Wedemeyer, Jochen, Kirstein, Martha M.
• Format: Article
• Language: English
• Subjects: Original article
• ISSN: 2364-3722; 2196-9736
• DOI: 10.1055/a-1990-0392

Abstract Background and study aims  Only a few studies are available regarding endoscopic vacuum-assisted closure (E-VAC) therapy for the post-surgery leakage of the lower gastrointestinal tract. Patients and methods  In this multicenter German study, we retrospectively analyzed patients treated with E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract from 2000–2020 at Hannover Medical School, University Medical Center Schleswig-Holstein, Campus Luebeck, and Robert Koch Hospital Gehrden. Results  Overall, 147 patients were included in this study. Most patients had undergone tumor resections of the lower gastrointestinal tract (n = 88; 59.9 %). Median time to diagnosis of leakage was 10 days (interquartile range [IQR] 6–19). Median duration of E-VAC therapy was 14 days (IQR 8–27). Increase of C-reactive protein (CRP) levels significantly correlated with first diagnosis of leakage ( P   100 mg/L (78.4 % vs. 52.7 %; P  = 0.012). Odds ratio for failure of stoma reversal was 3.36 in cases with CRP values > 100 mg/L ( P  = 0.017). In total, leakage- and/ or E-VAC therapy-associated complications occurred in 26 patients (17.7 %). Minor complications included recurrent E-VAC dislocations and subsequent stenosis. Overall, 14 leakage- or E-VAC-associated deaths were observed most often due to sepsis. Conclusions  E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract is safe and effective. High levels of CRP are a negative predictor of E-VAC therapy success.