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Outcome of endoscopic vacuum therapy for duodenal perforation

BACKGROUND: Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demon...

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Autores principales: Chevallay, Mickael, Lorenz, Florian, Bichard, Philippe, Frossard, Jean-Louis, Schmidt, Thomas, Goeser, Tobias, Bruns, Christiane Josephine, Mönig, Stefan P., Chon, Seung-Hun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9568927/
https://www.ncbi.nlm.nih.gov/pubmed/36241747
http://dx.doi.org/10.1007/s00464-022-09686-w
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author Chevallay, Mickael
Lorenz, Florian
Bichard, Philippe
Frossard, Jean-Louis
Schmidt, Thomas
Goeser, Tobias
Bruns, Christiane Josephine
Mönig, Stefan P.
Chon, Seung-Hun
author_facet Chevallay, Mickael
Lorenz, Florian
Bichard, Philippe
Frossard, Jean-Louis
Schmidt, Thomas
Goeser, Tobias
Bruns, Christiane Josephine
Mönig, Stefan P.
Chon, Seung-Hun
author_sort Chevallay, Mickael
collection PubMed
description BACKGROUND: Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks. METHODS: We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate. RESULTS: Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT was used as a first-line treatment in seven patients and as a second-line treatment in three patients. EVT was successfully applied in all interventions (n = 10, 100%). Overall, EVT lead to definitive closure of the defects in eight out of ten patients (80%). No severe EVT-related adverse events occurred. CONCLUSION: EVT is safe and technically feasible, so it emerges as a promising endoscopic treatment option for duodenal leaks. However, multidisciplinary collaboration and management are important to reduce the occurrence of postoperative complications, and to improve recovery rates.
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spelling pubmed-95689272022-10-16 Outcome of endoscopic vacuum therapy for duodenal perforation Chevallay, Mickael Lorenz, Florian Bichard, Philippe Frossard, Jean-Louis Schmidt, Thomas Goeser, Tobias Bruns, Christiane Josephine Mönig, Stefan P. Chon, Seung-Hun Surg Endosc Original Article BACKGROUND: Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks. METHODS: We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate. RESULTS: Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT was used as a first-line treatment in seven patients and as a second-line treatment in three patients. EVT was successfully applied in all interventions (n = 10, 100%). Overall, EVT lead to definitive closure of the defects in eight out of ten patients (80%). No severe EVT-related adverse events occurred. CONCLUSION: EVT is safe and technically feasible, so it emerges as a promising endoscopic treatment option for duodenal leaks. However, multidisciplinary collaboration and management are important to reduce the occurrence of postoperative complications, and to improve recovery rates. Springer US 2022-10-14 2023 /pmc/articles/PMC9568927/ /pubmed/36241747 http://dx.doi.org/10.1007/s00464-022-09686-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Chevallay, Mickael
Lorenz, Florian
Bichard, Philippe
Frossard, Jean-Louis
Schmidt, Thomas
Goeser, Tobias
Bruns, Christiane Josephine
Mönig, Stefan P.
Chon, Seung-Hun
Outcome of endoscopic vacuum therapy for duodenal perforation
title Outcome of endoscopic vacuum therapy for duodenal perforation
title_full Outcome of endoscopic vacuum therapy for duodenal perforation
title_fullStr Outcome of endoscopic vacuum therapy for duodenal perforation
title_full_unstemmed Outcome of endoscopic vacuum therapy for duodenal perforation
title_short Outcome of endoscopic vacuum therapy for duodenal perforation
title_sort outcome of endoscopic vacuum therapy for duodenal perforation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9568927/
https://www.ncbi.nlm.nih.gov/pubmed/36241747
http://dx.doi.org/10.1007/s00464-022-09686-w
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