Endoscopic Vacuum Therapy Was Omitted
The authors described in detail their experiences with the over the scope clip (OTSC) (1). Endoscopic clip application was reportedly the most studied procedure. Stent treatment was mentioned in passing; all other approaches were assessed as experimental, with reference to insufficient data or lacking availability. Endoscopic vacuum therapy (EVT) was not explained. We wish to comment on the article with regard to the treatment of esophageal defects.
Intracorporeal EVT is a further development of vacuum therapy, which thus far has been used on the body surface (2). It has been included in the therapeutic recommendations of the European Society of Gastrointestinal Endoscopy (ESGE) (3) and is reflected in the DRG system with specific codes for operations and procedures.
Since 2006 EVT has been used in esophageal defects. The literature documents experiences in more than 160 patients. Esophageal defects of any origin (postoperative anastomosis failure, iatrogenic perforations, and other perforations, including Boerhaave syndrome), localization, size, and possible infections were treated with a success rate of 70–100%. Three retrospective studies at the university hospitals in Kiel, Hanover, and Münster showed a treatment advantage compared with surgery and stent therapy. Our working group achieved a cure rate of 100% (median duration of treatment: five days) in 10 patients with iatrogenic esophageal perforation (4).
In our view, limitations for using OTSC in the esophagus include the need for an unrestricted direct view when applying the clip, the fact that a foreign body remains in the lumen, possible narrowing of the lumen, and involvement of extraluminal structures.
EVT is an innovative therapeutic approach for esophageal defects, which combines the two surgical therapeutic principles of closure and drainage. It can be used at all levels of the esophagus, for all defect sizes, and whether or not infection is present.
Dr. med. Gunnar Loske
Dr. med. Tobias Schorsch
Prof. Dr. med. Christian T. Müller
Klinik für Allgemein, Viszeral-, Thorax und Gefäßchirurgie
Katholisches Marienkrankenhaus gGmbH, Hamburg
Conflict of interest statement
Dr Loske has a personal relationship with Lohmann & Rauscher GmbH and is in receipt of honoraria for consultancy services.
Drs Schorsch and Müller declare that no conflict of interest exists.
|1.||Schmidt A, Fuchs KH, Caca K, Küllmer A, Meining A: The endoscopic treatment of iatrogenic gastrointestinal perforation. Dtsch Arztebl Int 2016; 113: 121–8 VOLLTEXT|
|2.||Mennigen R, Senninger N, Laukoetter MG: Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol 2014; 20: 7767–76 CrossRef MEDLINE PubMed Central|
|3.||Paspatis GA, Dumonceau J, Barthet M, et al.: Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2014; 693–711 CrossRef|
|4.||Loske G, Schorsch T, Dahm C, Martens E, Müller C: Iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT). Endosc Int Open 2015; 3: E547–51 CrossRef MEDLINE PubMed Central|