TY  - JOUR
A1  - Reimer, Stanislaus
A1  - Seyfried, Florian
A1  - Flemming, Sven
A1  - Brand, Markus
A1  - Weich, Alexander
A1  - Widder, Anna
A1  - Plaßmeier, Lars
A1  - Kraus, Peter
A1  - Döring, Anna
A1  - Hering, Ilona
A1  - Hankir, Mohammed K.
A1  - Meining, Alexander
A1  - Germer, Christoph-Thomas
A1  - Lock, Johan F.
A1  - Groneberg, Kaja
T1  - Evolution of endoscopic vacuum therapy for upper gastrointestinal leakage over a 10-year period: a quality improvement study
JF  - Surgical Endoscopy
N2  - Background
Endoscopic vacuum therapy (EVT) is an effective treatment option for leakage of the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate the clinical impact of quality improvements in EVT management on patients’ outcome.

Methods
All patients treated by EVT at our center during 2012–2021 were divided into two consecutive and equal-sized cohorts (period 1 vs. period 2). Over time several quality improvement strategies were implemented including the earlier diagnosis and EVT treatment and technical optimization of endoscopy. The primary endpoint was defined as the composite score MTL30 (mortality, transfer, length-of-stay > 30 days). Secondary endpoints included EVT efficacy, complications, in-hospital mortality, length-of-stay (LOS) and nutrition status at discharge.

Results
A total of 156 patients were analyzed. During the latter period the primary endpoint MTL30 decreased from 60.8 to 39.0% (P = .006). EVT efficacy increased from 80 to 91% (P = .049). Further, the need for additional procedures for leakage management decreased from 49.9 to 29.9% (P = .013) and reoperations became less frequent (38.0% vs.15.6%; P = .001). The duration of leakage therapy and LOS were shortened from 25 to 14 days (P = .003) and 38 days to 25 days (P = .006), respectively. Morbidity (as determined by the comprehensive complication index) decreased from 54.6 to 46.5 (P = .034). More patients could be discharged on oral nutrition (70.9% vs. 84.4%, P = .043).

Conclusions
Our experience confirms the efficacy of EVT for the successful management of UGI leakage. Our quality improvement analysis demonstrates significant changes in EVT management resulting in accelerated recovery, fewer complications and improved functional outcome.
KW  - anastomotic leak
KW  - gastrointestinal perforation
KW  - esophageal perforation
KW  - endoluminal
KW  - vacuum-assisted closure
KW  - negative pressure
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323953
VL  - 36
IS  - 12
ER  -