We are excited to share with you the latest advancements in endoscopic vacuum therapy in this week’s newsletter. This cutting-edge treatment continues to evolve, offering new solutions for gastrointestinal defects and improving patient outcomes.
Concepts and Principles Endoscopic Vacuum Therapy (Endoscopic Negative Pressure Therapy)
Endoscopic negative pressure therapy (ENPT) (also known as endoscopic vacuum therapy, EVT) was developed to close anastomotic intestinal leaks. Open-pored drains (made of polyurethane foam or a open-pored double-layer membrane) are placed endoscopically on the wound region and a continuous negative pressure is applied by means of an electronic vacuum pump. Two therapy variants can be distinguished, which can also be combined with each other: Intraluminal and intracavitary ENPT.
The three most important treatment principles of ENPT are 1) closure of the defect and drainage of secretions, 2) active drainage and removal of secretionsremoval of aggressive secretions, 3) promotion of granulation and healing. Interestingly, the principles of ENPT are the essential surgical characteristics defined by Kirschner 1926 for treatment of peritonitis (blocking the origin of infection and the elimination of exudate)!
From Sponges to Open Film Drainage
Initially, endoscopic vacuum therapy relied on the use of endo sponges. The endosponge can also be used around a self-expanding metal stent.
However, Dr. Gunnar Loske in Hamburg has developed a major advancement in endoscopic vacuum therapy by using open pore film drainage (OFD). This material is accessible in many countries worldwide and has demonstrated success in various luminal operations.
OFD is constructed with a drainage tube and a very thin double-layered open-pore drainage film (Suprasorb CNP, Drainage Film, Lohmann & Rauscher International, Germany). The distal end of the tube is wrapped with only one layer of film. OFD is placed into the gastrointestinal leakage site with common endoscopic techniques. The tube is connected to an electronic vacuum device and continuous negative pressure of -125 mmHg applied (1).
This endoscopic vacuum therapy features columns between two layers of the film that prevent collapse and maintain constant suction of material (1). The film adapts well to cavities and organs while preventing organ damage.
The following link takes you to the most complete site on endoscopic vacuum therapy:
Preemptive Endoscopic Vacuum Therapy
Another groundbreaking development in endoscopic vacuum therapy is its use in preventing post-operative leaks, especially after complex surgeries such as Ivor-Lewis (2). By applying the open drainage film at the site of surgery and attaching it to a feeding tube, surgeons can significantly reduce the chances of perforation and leaks.
Innovative Tube-in-Tube Technique
The tube-in-tube technique has broadened the applications of endoscopic vacuum therapy (3). This approach, which involves placing a smaller tube inside a larger one, has been particularly effective in cases where traditional sponges would have been too large. The tube-in-tube system has demonstrated remarkable healing capabilities, reducing wound sizes and cavities within a relatively short time frame.
Endoscopic vacuum therapy, based on the principle of secondary wound healing, is an essential option for closing large and complex gastrointestinal defects. The technique has evolved from sponge-based therapy to open film drainage and tube-in-tube methods, making it easier to deploy and more effective.
By using endoscopic vacuum therapy preemptively, surgeons can now prevent post-operative leaks and improve patient outcomes.
Stay up to date with the latest advancements in gastrointestinal treatments and don't miss our upcoming lectures on EndoCollab. On endocollab.com you can access top lectures on any aspects of GI endoscopy, including the entire spectrum and applications of endoscopic vacuum therapy.
Wishing you a great day!
Endoscopic Vacuum Therapy on EndoCollab
Endoscopic Vacuum Therapy - Advances and Evolution
Endoscopic Vacuum Therapy - How to Place
Endoscopic Vacuum Therapy Using Open Pore Sheets Instead of Foam
Principles of Endoscopic Vacuum Therapy
Endoscopic Vacuum Therapy - Master Lecture
SPECIAL INTERVIEW with the pioneer in EVT Dr. Gunnar Loske: Endoscopic vacuum therapies (EVT)
Loske G, Schorsch T, Rucktaeschel F, Schulze W, Riefel B, van Ackeren V, Mueller CT. Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT). Endosc Int Open. 2018 Jul;6(7):E865-E871. doi: 10.1055/a-0599-5886. PMID: 29978007; PMCID: PMC6031437.
Loske G, Müller J, Schulze W, Riefel B, Müller CT. Pre-emptive active drainage of reflux (PARD) in Ivor-Lewis oesophagectomy with negative pressure and simultaneous enteral nutrition using a double-lumen open-pore film drain (dOFD). Surg Endosc. 2022 Jan 1. doi: 10.1007/s00464-021-08933-w. PMID: 34973079.
Simas de Lima M, Uemura RS, Gusmon-Oliveira CC, Pombo AAM, Martins BC, Lenz L, Kawaguti FS, De Paulo GA, Baba ER, Safatle-Ribeiro AV, Ribeiro U Jr, Monkemüller K, Maluf-Filho F. Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations. Endoscopy. 2022 Oct;54(10):980-986. doi: 10.1055/a-1774-4630.. PMID: 35378562.