GI Endoscopy · 3 min read
Terapia Endoscopica Vacuum: Nuevo Metodo Simple, Economico, Eficaz y Reproducible
COURSE VIDEO
Course: Mi caja médica de herramientas 🧰
Endoscopic Vacuum (E-VAC) Therapy: A Practical Guide to Managing Complex Anastomotic Leaks
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Endoscopic Vacuum (E-VAC) Therapy: A Practical Guide to Managing Complex Anastomotic Leaks
A Step-by-Step Case Study on Treating Multiple Esophagojejunal Dehiscence
Course Outline
Module 1: Introduction and Clinical Context
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1.1. Course Instructors:
Dr. Pardo Bárbara (Gastroenterologist & Therapeutic Endoscopist)
Dr. Lombardi Giuliana (Gastroenterologist & Therapeutic Endoscopist)
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1.2. Learning Objectives:
Understand the application of E-VAC therapy for complex post-surgical leaks.
Learn to identify and diagnose multiple points of anastomotic dehiscence.
Master the assembly of a low-cost, effective homemade E-VAC device.
Observe the technique for intraluminal placement and management.
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1.3. Target Audience:
Gastroenterology and Surgery Fellows/Residents
Practicing Gastroenterologists and Therapeutic Endoscopists
General and Upper GI Surgeons
Module 2: The Clinical Challenge: A Case of Multiple Anastomotic Dehiscence
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2.1. Patient History:
59-year-old male with a history of total laparoscopic gastrectomy for type 1 gastric neuroendocrine tumors.
Surgical anatomy: Esophago-jejunal end-to-side anastomosis.
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2.2. The Complication:
72 hours post-op: Increased output from surgical drains.
Clinical suspicion of anastomotic leak.
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2.3. Diagnostic Endoscopy (VEDA): Identifying the Defects
Visualizing the anastomosis.
Finding #1: A 10% dehiscence with fibrin.
Finding #2: A 20% dehiscence with a visible drainage tube inside the lumen.
Finding #3: A separate 3-4 mm fistulous orifice at the jejunal suture line.
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2.4. Diagnosis & Treatment Plan:
Official Diagnosis: Multiple esophago-jejunal anastomotic dehiscence with a jejunal fistula.
Chosen Therapeutic Strategy: Endoscopic Vacuum (E-VAC) Therapy.
Module 3: The Homemade E-VAC Device: Assembly and Preparation
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3.1. Required Materials:
Gauze or Polyurethane Sponge
Ruler & Scissors
Silicone Tube (16-18 Fr)
Transparent Adhesive Film (e.g., Tegaderm)
Nylon Suture (mounted on a straight needle)
IV Catheter (e.g., Abbocath 20G)
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3.2. Step-by-Step Assembly Guide (Video Demonstration):
Step 1: Preparing the Tube: Creating multiple fenestrations along the distal end to maximize suction area.
Step 2: Preparing the Sponge: Measuring and cutting the gauze/sponge to the required length (10-11 cm in this case).
Step 3: Creating the Core: Tightly wrapping the sponge around the fenestrated portion of the tube.
Step 4: Sealing the Device: Encasing the sponge-wrapped tube with the adhesive film.
Step 5: Securing the Device: Using nylon suture to fix the sponge and film to the tube in a crisscross pattern for stability.
Step 6: Final Touches: Passing a retrieval suture through the distal tip for controlled placement and removal.
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3.3. Pre-Placement System Check:
Connecting the device to a vacuum system.
Testing suction and confirming collapse (demonstrated with a glove).
Module 4: The Therapeutic Procedure: Intraluminal E-VAC Placement
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4.1. Insertion Technique:
Advancing the E-VAC device through the nasal passage.
Using the endoscope to guide the device to the site of the leak.
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4.2. Positioning and Fixation:
Using forceps to carefully position the device to cover all three leak sites intraluminally.
Technique for withdrawing the endoscope while leaving the E-VAC device in place.
Module 5: Patient Management and Treatment Outcome
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5.1. Treatment Protocol & Follow-up:
Total of 4 therapeutic endoscopies (1 placement, 2 changes, 1 final removal).
Patient management during the 30-day hospital stay (hemodynamic stability, jejunostomy feeding).
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5.2. Evaluating Success: The Final Endoscopy
Visual evidence of complete closure of all three dehiscence/fistula sites.
A "before and after" comparison showcasing the healing process.
Module 6: Conclusion and Key Takeaways
6.1. Summary of the Case: A review of the successful management of a complex, multifocal anastomotic leak.
6.2. Why E-VAC Works: A brief discussion on the mechanism (drainage, granulation tissue promotion, reduced edema).
6.3. Final Remarks: E-VAC therapy is a safe, effective, and reproducible technique that can be implemented with readily available materials, offering significant benefits to the patient.
6.4. Q&A and Contact Information.
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