First Report of Intraluminal Endoscopic Negative Pressure Therapy (ENPT) for Anastomotic Prophylaxis in a Case of Tubular Resection of Cervical Esophagus

Gunnar Loske, Tobias Schorsch and Christian Theodor Müller

Department for General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Germany

^*Correspondance to: Gunnar Loske 

 PDF  Full Text DOI: 10.25107/2474-1647.1500

Abstract

Introduction: Endoscopic Negative Pressure Therapy (ENPT) presents a novel treatment option for leaks in the upper gastrointestinum. We report a first use of intraluminal ENPT for intraoperative anastomotic prophylaxis in a case of high cervical tubular esophageal resection. Material and Method of Intraluminal ENPT: For intraluminal ENPT open-pore drainage is constructed by suturing open-pore polyurethane foam at the tip of a drainage tube. Then the drainage is placed in the esophageal lumen by endoscopic means. Negative pressure is applied with an electronic vacuum device. Esophageal lumen is occluded and drained by suction simultaneously.Case Report: A 46 year old woman underwent tubular resection of the upper esophagus because of a retroesophageal schwannoma. Cervical end-to-end esophago-esophagostomy anastomosis was hand sewn just below the upper esophageal sphincter. Then open-pore polyurethane foam drainage was placed intraluminal covering the whole anastomotic region and vacuum was applied.Results: Prophylactic ENPT ended after three days. Perfusion was excellent, no edema, ulceration or local inflammation were seen. Because of temporary left sided vocal cord paralyses artificial ventilation went on for one week postoperative. Endoscopy confirmed normal healing without stenosis in long term follow up.Conclusion: This first report is a single observation of the use of ENPT for intraoperative anastomotic prophylaxis. We suppose, prophylactic intraluminal ENPT might reduce the incidence of anastomotic leaks. Further studies are needed.

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Cite the article

Loske G, Schorsch T, Muller CT. First Report of Intraluminal Endoscopic Negative Pressure Therapy (ENPT) for Anastomotic Prophylaxis in a Case of Tubular Resection of Cervical Esophagus. Clin Surg. 2017; 2: 1500.