Endoluminal vacuum therapy for the management of Boerhaave syndrome: a case series
File(s)
Author(s)
Soussi, Daniella
Alharahsheh, Batool Helmi Ahmad
Boshier, Piers Robert
Hoare, Jonathan
Direkze, Natalie
Type
Journal Article
Abstract
Introduction: Boerhaave syndrome is a rare condition associated with high morbidity and mortality. Prompt intervention greatly improves outcomes, with surgery traditionally being the mainstay of management. Recent advances in therapeutic endoscopy have led to increasing interest in endoluminal vacuum therapy (EVT), a minimally invasive technique, allowing wound debridement and drainage, encouraging granulation tissue formation. EVT has been associated with positive clinical outcomes, including lower mortality rates compared to surgery and stenting for the management of anastomotic leaks, and to a lesser extent, oesophageal perforations. EVT has been adopted into practice across Europe; however, only few cases have been reported from the UK. Case Presentations: We report three cases of Boerhaave syndrome, successfully managed with EVT, using the Eso-SPONGE ® (B.Braun Medical Ltd, Sheffield, UK). EVT involves the placement of a polyurethane sponge into the wound cavity. The cavity is initially assessed, then an overtube is introduced through which the sponge is inserted, and then the overtube is removed. Sponge position is confirmed and adjusted if necessary. The sponge is connected via a trans-nasal drain to continuous negative pressure suction and is changed every 3–5 days. Having been deemed surgically unfit, all 3 patients were referred for EVT. All patients made excellent recovery and were discharged home. Conclusion: EVT is an effective management strategy for surgically unfit Boerhaave syndrome patients. Eso-SPONGE use aided drainage of the septic focus and closure of the defect, leading to complete recovery. Our findings support the existing evidence that EVT is a promising solution for Boerhaave syndrome.
Date Issued
2024-01-01
Date Acceptance
2024-07-24
Citation
Case Reports in Gastroenterology, 2024, 18 (1), pp.402-411
ISSN
1662-0631
Publisher
Karger Publishers
Start Page
402
End Page
411
Journal / Book Title
Case Reports in Gastroenterology
Volume
18
Issue
1
Copyright Statement
© 2024 The Author(s). This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) (http://www. karger.com/Services/OpenAccessLicense). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39474156
PII: 540694
Subjects
ASSISTED CLOSURE
Boerhaave syndrome
Case report
DEFECTS
Endoluminal vacuum therapy
Gastroenterology & Hepatology
LEAKS
Life Sciences & Biomedicine
Oesophageal perforation
Science & Technology
Therapeutic endoscopy
Publication Status
Published
Coverage Spatial
Switzerland
Date Publish Online
2024-08-28