Eso-SPONGE®

Endoluminale Vakuum-Therapie zur Behandlung der Anastomoseninsuffizienz des oberen GI-Traktes

Produktbild CW Vergrößerung
Eso-SPONGE®
Produktbild Vergrößerung CW
Eso-SPONGE®
Produktbild Vergrößerung CW
Eso-SPONGE®
Produktbild CW Vergrößerung
Eso-SPONGE®
Produktbild Vergrößerung CW
Eso-SPONGE®
Produktbild Vergrößerung CW
Eso-SPONGE®

Eine Nahtinsuffizienz der Anastomose oder andere Leckagen am oberen Gastrointestinaltrakt können schwerwiegende Folgen für die betroffenen Patienten haben. Verschiedene Parameter, wie die Größe, die Lokalisation, die Latenzzeit bis zur Diagnosestellung der Läsion, aber auch der Allgemeinzustand des Patienten haben einen erheblichen Einfluss auf den klinischen Verlauf.
Häufig geht diese Befundkonstellation mit einem septischen Krankheitsbild einher, und in schweren Fällen ist eine relevante Morbiditätsrate mit entsprechender Mortalität die Folge.

Eso-SPONGE® ist ein innovatives Therapiekonzept, welches erheblich zur Verringerung der Morbidität und Mortalität der Patienten beiträgt [4, 17-21, 26-31, 33-41, 46, 47, 49]

Die Insuffizienzhöhle wird durch das endoskopisch eingebrachte Schwammsystem Eso-SPONGE® mit Anschluss an eine regelbare, medizinische Pumpe drainiert. Durch die offenen Poren des Schwammes wir der Sog gleichmäßig auf das gesamte mit der Oberfläche des Schwammes in Kontakt stehende Gewebe übertragen.

Vorteile

  • Kontinuierliche Drainage, kein Sekretstau [4,5, 9, 18, 19, 21, 29 34, 35, 46, 47,49]
  • Infektkontrolle [4,5, 9, 18, 19, 21, 29 34, 35, 46, 47,49]
  • Debridement, rasche Säuberung der Wundhöhle [4,5, 9, 18, 19, 21, 29 34, 35, 46, 47,49]
  • Granulationsförderung [4,5, 9, 18, 19, 21, 29 34, 35, 46, 47,49]
  • Mechanische Verkleinerung der Wundhöhle [4,5, 9, 18, 19, 21, 29 34, 35, 46, 47,49
  • Erfolgreicher Verschluss der Leckage oder Perforation bei 95% der Patienten (77.9 - 100%) [18, 19, 29, 34, 46-48] [49] [21] [35]
  • Gut verträglich mit guten kurz- und langfristigem klinischen Ergebnis [4, 17-21, 26-31, 33-41, 46, 47, 49]
  • Behandlungsdauer ca. 1 bis 30 Tage [18, 19, 21, 29, 34, 35 46-48, 49]
  • Kann mit enteraler Ernährung kombiniert werden [18, 29, 34, 46-48]
  • Scheint der Stent Behandlung überlegen zu sein, weniger chirurgische Revision und weniger Strikturen [17, 21, 27, 28, 33-36]

1. Kapoor, V.K. Upper GI Tract Anatomy. Anatomy 2016 28/06/2016 09/05/2019];
Available from: https://emedicine.medscape.com/article/1899389-overview#showall.

2. Leeds, S.G., J.S. Burdick, and J.W. Fleshman, Endoluminal Vacuum Therapy for
Esophageal and Upper Intestinal Anastomotic Leaks. JAMA Surgery, 2016. 151(6): p. 573-574.

3. Bemelman, W.A. and T.H. Baron, Endoscopic Management of Transmural Defects, Including Leaks, Perforations, and Fistulae. Gastroenterology, 2018. 154(7): p. 1938-1946.e1.

4. Loske, G., Endoscopic negative pressure therapy of the upper gastrointestinal
tract. Chirurg, 2019. 90: p. 1-6.

5. Loske, G.M., C.T.,, Tips and tricks for endoscopic negative pressure therapy.
Chirurg, 2019. 90: p. 7-17.

6. Shen, B., et al., Role of interventional inflammatory bowel disease in the era of
biologic therapy: a position statement from the Global Interventional IBD Group.
Gastrointestinal Endoscopy, 2019. 89(2): p. 215-237.

7. Gabr, A., Sealing the hole: endoscopic management of acute gastrointestinal
perforations. Frontline Gastroenterology, 2019: p. 101136.

8. Rodrigues-Pinto, E., et al., Choosing the Appropriate Endoscopic Armamentarium
for Treatment of Anastomotic Leaks. American Journal of Gastroenterology, 2018. 114(3).

9. Comellas, E., et al., On the feasibility of the computational modelling of the endoluminal vacuum-assisted closure of an oesophageal anastomotic leakage. Royal Society Open Science, 2018. 5(2): p. 171289.

10. Heits, N., Egberts JH, Schniewind B, Hampe J, Becker T, Schafmayer C, Endoscopic-Vacuum-Therapy in Esophgageous Perforations and AnastomoticLeakages after Esophagectomy. The Best Treatment Option to Solve a Major Complication in Upper GI-Surgery? Clin Surg, 2016. 1.

11. Holscher, A.H., D. Vallbohmer, and J. Brabender, The prevention and management of perioperative complications. Best Pract Res Clin Gastroenterol, 2006. 20(5): p. 907-23.

12. Schaheen, L., S.H. Blackmon, and K.S. Nason, Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg, 2014. 208(4): p. 536-43.

13. Sdralis, E.I.K., et al., Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus, 2017. 30(8): p. 1-6.

14. Di Leo, M., et al., Endoscopic Management of Benign Esophageal Ruptures and Leaks. Curr Treat Options Gastroenterol, 2017. 15(2): p. 268-284.

15. Blencowe, N.S., et al., Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg, 2012. 255(4): p. 658-66.

16. Fumagalli, U., et al., Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks.World journal of gastroenterology, 2019. 25(3): p. 356-366.

17. Schniewind, B., et al., Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc, 2013. 27(10): p. 3883-90.

18. Kuehn, F., Schiffmann, L., Janisch, F. et al. ,, Surgical Endoscopic Vacuum Therapy for Defects of the Upper Gastrointestinal Tract. J Gastrointest Surg, 2016. 20(2): p. 237-243.

19. Heits, N., et al., Long-term quality of life after endovac-therapy in anastomotic leakages after esophagectomy. Journal of thoracic disease, 2018. 10(1): p. 228-240.

20. Smallwood, N.R., et al., The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surgical Endoscopy, 2016. 30(6): p. 2473-2480.

21. Morell, B., Murray, F., Vetter, D. et al.,, Endoscopic vacuum therapy (EVT) for early infradiaphragmal leakage after bariatric surgery􀂲outcomes of six consecutive cases in a single institution. Langenbecks Arch Surg 2019. 404.

22. Dasari, B.V., et al., The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg, 2014. 259(5): p. 852-60.

23. Verlaan, T., et al., Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature. Gastrointest Endosc, 2015. 82(4): p. 618-28.e5.

24. Persson, S., et al., Outcomes following the main treatment options in patients with a leaking esophagus: a systematic literature review. Dis Esophagus, 2017. 30(12):p. 1-10.

25. Pines, G., et al., Modified Endoscopic Vacuum Therapy for Nonhealing Esophageal Anastomotic Leak: Technique Description and Review of Literature. Laparoendosc Adv Surg Tech A, 2018. 28(1): p. 33-40.

26. Laukoetter, M.G., et al., Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc, 2016. 31(6): p. 2687-2696.

27. Brangewitz, M., et al., Endoscopic closure of esophageal intrathoracic leaks: stent
versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy, 2013. 45(6): p. 433-8.

28. Mennigen, R., et al., Comparison of Endoscopic Vacuum Therapy Versus Stent for Anastomotic Leak After Esophagectomy. J Gastrointest Surg, 2015. 19(7): p.1229-35.

29. Gubler, C., et al., Preemptive endoluminal vacuum therapy to reduce anastomotic leakage after esophagectomy: a game-changing approach? 2018.

30. Neumann, P.-A., Mennigen, R, Palmes, D, Senninger, N, Vowinkel, T, Laukoetter,
M. G,, Pre-emptive endoscopic vacuum therapy for treatment of anastomotic ischemia after esophageal resections. Endoscopy, 2017.

31. Möschler, O., Nies, C. and Mueller MK. Endoscopic vacuum therapy for esophageal perforations and leakages. Endoscopy international open, 2015. 3(6): p. E554-E558.

32. Bludau, M., et al., Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc, 2014. 28(3): p. 896-901.

33. Hwang, J.J., et al., Comparison of Endoscopic Vacuum Therapy and Endoscopic Stent Implantation With Self-Expandable Metal Stent in Treating Postsurgical Gastroesophageal Leakage. Medicine (Baltimore), 2016. 95(16): p. e3416.

34. Bludau, M., Fuchs, H.F., Herbold, T. et al.,, Results of endoscopic vacuumassisted closure device for treatment of upper GI leaks. Surg Endosc, 2018. 32.

35. Valli, P.V., et al., Stent-over-sponge (SOS): a novel technique complementing endosponge therapy for foregut leaks and perforations. Endoscopy, 2017. 50(02): p. 148-153.

36. Rausa, E., et al., Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis. Dis Esophagus, 2018. 31(11).

37. Pournaras, D.J., et al., Endoluminal Vacuum Therapy (E-Vac): A Treatment Option in esophagogastric Surgery.World Journal of Surgery, 2018. 42(8): p.2507-2511.

38. Heits, N., et al., Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg, 2014. 97(3): p. 1029-35.

39. Weidenhagen, R., et al., Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg, 2010. 90(5):p. 1674-81.

40. Loske, G., et al., Iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT). Endoscopy international open, 2015. 3(6): p.E547-E551.

41. Ooi, G., et al., Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. ANZ J Surg, 2018. 88(4): p. E257-e263.

42. Mencio, M.A., et al., Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience. Surg Endosc, 2018. 32(7): p. 3349-3356.

43. Manfredi, M.A., et al., Endoscopic Esophageal Vacuum Therapy: A Novel Therapy for Esophageal Perforations in Pediatric Patients. J Pediatr Gastroenterol Nutr, 2018. 67(6): p. 706-712.

44. Higgins, J.P.T., et al., The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ, 2011. 343: p. d5928.

45. Sterne, J.A.C., et al., ROBINS-I: a tool for assessing risk of bias in nonrandomized studies of interventions. BMJ, 2016. 355: p. i4919.

46. Alakkari, A., et al., First UK experience of endoscopic vacuum therapy for the management of oesophageal perforations and postoperative leaks. Frontline Gastroenterology, 2019. 10(2): p. 200-203.

47. Chon, S.-H., et al., Successful closure of a gastropulmonary fistula after esophagectomy using the Apollo Overstitch and endoscopic vacuum therapy. Endoscopy, 2018. 50(07): p. E149-E150.

48. Glatz, T., et al., Vacuum sponge therapy using the pull-through technique via a percutaneous endoscopic gastrostomy to treat iatrogenic duodenal perforation. Endoscopy, 2015. 47 Suppl 1: p. E567-8.

49. Herbold, T., et al., Endoscopic Treatment of Transesophageal Echocardiography- Induced Esophageal Perforation. Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018. 28(4): p. 422-428.

50. Kuehn, F., et al., Surgical endoscopic vacuum therapy for anastomotic leakage and perforation of the upper gastrointestinal tract. J Gastrointest Surg, 2012. 16(11): p. 2145-50.

51. Schroder, W., et al., [Perforations near the cardia in benign diseases]. Chirurg, 2014. 85(12): p. 1064-72.

52. Mennigen, R., N. Senninger, and M.G. Laukoetter, Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips.World journal of gastroenterology, 2014. 20(24): p. 7767-
7776.