NDLI: Novel treatment options for perforations of the upper gastrointestinal tract: Endoscopic vacuum therapy and over-the-scope clips

Content Provider	PubMed Central
Author	Mennigen, Rudolf Norbert, Senninger Laukoetter, Mike G.
Copyright Year	2014
Abstract	Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure: endoscopic vacuum therapy (EVT), and over-the-scope clip (OTSC). EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage. Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing, comparable to the application of vacuum therapy in cutaneous wounds. The system is changed every 3-5 d. The overall success rate of EVT in the literature ranges from 84% to 100%, with a mean of 90%; only few complications have been reported. OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope. By bringing the edges of the perforation into the cap, by suction or by dedicated devices, such as anchor or twin grasper, the OTSC can be placed to close the perforation. For acute endoscopy associated perforations, the mean success rate is 90% (range: 70%-100%). For other types of perforations (postoperative, other chronic leaks and fistulas) success rates are somewhat lower (68%, and 59%, respectively). Only few complications have been reported. Although first reports are promising, further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations.
Related Links	http://dx.doi.org/10.3748/wjg.v20.i24.7767
Ending Page	7776
Page Count	10
Starting Page	7767
File Format	PDF
ISSN	10079327
e-ISSN	22192840
Journal	World Journal of Gastroenterology : WJG
Issue Number	24
Volume Number	20
Language	English
Publisher	Baishideng Publishing Group Inc
Publisher Date	2014-01-01
Access Restriction	Open
Rights Holder	Baishideng Publishing Group Inc
Subject Keyword	Gastroenterology Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Gastroenterology

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