From the Guidelines
This describes the placement of an endovac system, specifically an endoscopic vacuum-assisted closure device, to treat a gastrointestinal perforation. The procedure involves passing a nasogastric tube (NGT) through the patient's nostril and out through the mouth. A black foam sponge is cut to size (7cm) and attached to a 14-French NGT using prolene sutures, with a loop created for later removal. Using endoscopic guidance, the vacuum device is positioned directly at the perforation site. The NGT is then secured to the patient's nose with a bridle system and connected to continuous suction via a wound vacuum system. This therapy creates negative pressure at the perforation site, which helps drain secretions, reduce contamination, promotes tissue granulation, and accelerates healing of the perforation.
According to the most recent and highest quality study, endoscopic closure of gastric perforations should be pursued when feasible, utilizing TTSCs or OTSCs for perforations <2 cm and endoscopic suturing or combination of TTSCs and endoloop for perforations >2 cm 1. Endovac therapy is particularly useful for managing gastrointestinal perforations or leaks when surgical intervention may be challenging or risky. The use of endoscopic vacuum therapy has been reported to be a promising alternative treatment for esophageal perforation, with successful closure of esophageal defects by primary or rescue endoluminal vacuum therapy 1.
Key points of the procedure include:
- Passing a nasogastric tube (NGT) through the patient's nostril and out through the mouth
- Attaching a black foam sponge to a 14-French NGT using prolene sutures
- Positioning the vacuum device directly at the perforation site using endoscopic guidance
- Securing the NGT to the patient's nose with a bridle system and connecting to continuous suction via a wound vacuum system
- Creating negative pressure at the perforation site to promote healing and reduce contamination.
The goal of this therapy is to promote tissue granulation, accelerate healing, and reduce morbidity and mortality associated with gastrointestinal perforations. As noted in a study on the management of intra-abdominal infections, negative pressure techniques have become the most extensively employed means of temporary closure of the abdominal wall, and rapid closure with the assistance of negative pressure therapy should be the primary objective in the management of patients with open abdomen 1.
From the Research
Description of the Procedure
The text describes a medical procedure involving the placement of an endovac (endoscopic vacuum-assisted closure) device to treat a perforation in the upper gastrointestinal tract. The procedure involves:
- Passing a nasogastric tube (NGT) through the patient's nostril and mouth
- Attaching a black sponge to the NGT with prolene sutures
- Creating a loop for future retrieval
- Endoscopically placing the vac at the area of the perforation
- Bridling the NGT to the patient's nose and applying continuous suction via the wound vac
Relevant Studies
The procedure is consistent with the description of endoscopic vacuum-assisted closure (EndoVAC) therapy in studies such as 2, which reported a success rate of 80-90% in treating upper gastrointestinal perforations and leaks. Other studies, including 3 and 4, also describe the use of endoscopic vacuum therapy for the treatment of upper gastrointestinal fistulas, leaks, and perforations, with reported success rates ranging from 84% to 100%. The use of a tube-in-tube endoscopic vacuum therapy, as described in 4, is a modification of the traditional EndoVAC technique. Additionally, study 5 presents a case series and literature review of endoluminal vacuum-assisted closure therapy for upper gastrointestinal leak, perforation, and fistula, highlighting its effectiveness in treating these conditions.
Key Points
- The procedure involves the use of an endovac device to treat a perforation in the upper gastrointestinal tract
- The device is placed endoscopically and applies continuous suction to promote healing
- The procedure is consistent with the description of EndoVAC therapy in several studies, including 2, 3, 4, and 5
- The success rate of EndoVAC therapy in treating upper gastrointestinal perforations and leaks is reported to be 80-90% in study 2 and 84-100% in study 3