Dados do Trabalho

Título

Innovations in endoscopic vacuum application for esophagogastric anastomosis: Prophylactic approach.

Introdução

Vacuum endoscopic therapy is a minimally invasive approach, which aims to treat severe postoperative complications, such as anastomotic fistulas, fistulas and perianastomotic collections, avoiding a new surgical approach. This therapy consists of applying negative pressure with a sponge on the wound in order to accelerate the healing process, improving perfusion, microdeformation, macrodeformation and bacterial control. Therefore, its prophylactic use, especially in high-risk patients, aims to prevent these possible complications.

Objetivo

Evaluate the effectiveness of using endoscopic vacuum therapy prophylactically in patients undergoing esophagectomy.

Método

We performed a prospective study with prophylactic application of endoscopic vacuum in patients over 18 years of age who underwent total esophagectomy with gastric tube reconstruction from July 2020 to January 2021, developed by a single thoracic surgery and endoscopy group in the city of Brasilia.
The patients underwent endoscopic evaluation of the anastomosis, immediately after making the esophagogastric anastomosis. Those with integration of the anastomosis and without complications were submitted to the application of prophylactic vacuum endoscopic treatment, using a triple lumen probe with a polyurethane sponge and application of 125 mmHg, continuous and high intensity negative pressure. Endoscopic review was scheduled for 5 days. Patients with anastomosis had therapy terminated and those with ischemia or leakage continued with EVT until they were healed.

Resultados

Intraoperative prophylactic VTE after esophagectomy was performed in 5 patients at a Brazilian tertiary center. Patients had a mean follow-up of 54.6 days (ranging from 23 to 80 days). In all patients, endoscopy was performed for post-surgical evaluation. No complications were observed. Median PEVT duration was 9 days (range 5-65) and median 1 sponge change (range 0-12). Of the 5 patients, 2 developed anastomotic leak, which resolved with continued EVT.

Conclusão

The use of intraoperative PEVT helps in the primary prophylaxis of anastomosis complications, especially in patients who are at an increased risk of developing them. In addition, the use of the triluminal artisanal device allows enteral feeding and negative pressure with a single technique.

Palavras-Chave

Pre-emptive endoscopic vacuum therapy; Endoscopic vacuum therapy;