Endoscopic Vacuum Therapy for Upper Gastrointestinal Leaks and Perforations: Analysis From a Multicenter Spanish Registry.

Autor:	Momblan D; Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain., Gimeno Garcia AZ; Department of Gastroenterology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain., Busquets D; Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Doctor Josep Trueta, Girona, Spain., Juzgado D; Department of Gastroenterology, Hospital Quirón Madrid, Madrid, Spain., García Lledó J; Department of Gastroenterology, Hospital General Universitario Gregorio Marañon, Madrid, Spain., Ferrero E; Department of General and Digestive Surgery, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain., Tejedor-Tejada J; Department of Gastroenterology, Hospital Universitario de Cabueñes, Asturias, Spain., Junquera F; Department of Gastroenterology, Hospital de Sabadell, Institut d´Investigació i Innovació Parc Taulí I3PT, CIBERehd, Sabadell, Spain., Díaz-Tasende J; Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain., Moris M; Department of Gastroenterology and Hepatology, Hospital Universitario Marques de Valdecilla, Santander, Spain., Rodriguez de Santiago E; Department of Gastroenterology and Hepatology, IRYCIS, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain., Gornals J; Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain., Garrido C; Endoscopy Unit, Department of Gastroenterology, Son Espases University Hospital, Illes Balears, Spain., Gonzalez-Vazquez S; Department of Gastroenterology, University of Navarra Clinic, Madrid, Spain., Guarner-Argente C; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Repiso A; Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain., Esteban JM; Endoscopy Unit, Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain., Loras C; Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua de Terrassa, Terrassa, Spain., Seoane A; Department of Gastroenterology, Hospital del Mar Medical Research Institute, Barcelona, Spain., Fernández-Simon A; Endoscopy Unit, Department of Gastroenterology, Hospital Clinic de Barcelona, Barcelona, Spain., Guevara HC; Endoscopy Unit, Department of Gastroenterology, IDIBAPS, CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain., Ibarzabal A; Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain., Morales X; Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain., Curell A; Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain., Cardenas A; Endoscopy Unit, Department of Gastroenterology, IDIBAPS, CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain., Ríos J; Department of Clinical Farmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain., de Lacy AM; Department of Gastrointestinal Surgery, ICMDM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic de Barcelona, Barcelona, Spain., Sendino O; Endoscopy Unit, Department of Gastroenterology, IDIBAPS, CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2023 Oct 01; Vol. 118 (10), pp. 1797-1806. Date of Electronic Publication: 2023 Sep 25.
DOI:	10.14309/ajg.0000000000002475
Abstrakt:	Introduction: Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. Methods: This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. Results: We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5-133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15-5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. Discussion: EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique. (Copyright © 2023 by The American College of Gastroenterology.)
Databáze:	MEDLINE
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