Preemptive Application of VACStent: A game changer in Managing Anastomotic Leakage in the Gastrointestinal Tract

Significance 

Anastomotic leakage (AL) refers to the leakage of fluid or contents from a surgical connection or anastomosis between two structures, typically in the gastrointestinal tract. It is a potentially serious complication that can occur after various types of surgeries, such as after esophagectomy with reported insufficiency rates of up to 15%. Traditional treatments, such as endoluminal endoscopic vacuum therapy (EVT) or covered stents, have limitations including obstruction of the gastrointestinal (GI) tract and a high rate of migration. In a new study published in the Journal Frontiers in Surgery, Dr. Jonas Lange, Dr. Claus Ferdinand Eisenberger, Dr. Judith Knievel, Dr. Anne Linderer, and led by Professor Markus Maria Heiss from the Witten/Herdecke University in Germany introduced a novel approach using the VACStent, a combination of a fully covered stent within a polyurethane sponge cylinder, to address these limitations and enhance clinical outcomes. The authors highlighted the potential of preemptive VACStent application as a promising option for managing anastomotic leakage in hybrid esophagectomy. This approach offers several advantages, including improved clinical outcomes, avoidance of critical situations, and the ability to validate its efficacy in a larger clinical study.

In their study, the research team enrolled 9 high-risk patients with anastomosis after neoadjuvant therapy undergoing hybrid esophagectomy. The VACStent was preemptively applied to assess its efficacy in reducing the AL rate, postoperative morbidity, and mortality. The authors reported technical success in all interventions, with one patient experiencing AL 10 days after esophagectomy. The patient was successfully treated with two consecutive VACStents and a VAC Sponge. Notably, there were no in-hospital mortalities, septic episodes, or severe device-related adverse events. Anastomotic healing was uneventful, and oral intake of liquids and food was documented in all patients. The VACStent demonstrated uncomplicated handling and removal.

The researchers demonstrated that the VACStent was easy to insert and effectively sealed off esophageal leakage and anastomotic failure, allowing the passage of liquids and mashed food. The improved VACStent design eliminated luminal narrowing issues observed in previous studies. Importantly, the study revealed no significant adverse events, migrations, or dislocations associated with the VACStent.

The concept of preemptive EVT with the VACStent holds promise, as it enables early assessment of anastomotic healing and immediate treatment if leakage occurs. This approach can prevent the development of septic complications. However, late complications, such as anastomotic strictures, should be carefully evaluated in future prospective clinical trials.

The pilot study demonstrated the applicability and efficacy of preemptive VACStent treatment in managing endoscopic esophageal resection. The VACStent proved to be a safe and feasible endoscopic option, promoting primary anastomotic healing while allowing effective drainage. The results indicated that preemptive VACStent application may reduce AL formation and related morbidity, particularly in high-risk patients. Indeed, although the authors focused on high-risk patients with neoadjuvant therapy undergoing esophagectomy, the findings have broader implications. The positive results obtained with the VACStent could be extended to other challenging anastomoses, such as those encountered in bariatric surgery or other difficult esophageal-gastric procedures. This widens the potential applications of the VACStent beyond the specific patient population studied.

The findings of Professor Markus Maria Heiss and his colleagues provided a strong foundation for further investigation through large-scale clinical studies. If validated, preemptive endoluminal vacuum therapy with the VACStent could revolutionize the management of upper GI tract leaks and offer substantial benefits to patients undergoing esophagectomy.

Reference

Lange J, Eisenberger CF, Knievel J, Linderer A, Heiss MM. Preemptive endoluminal vacuum therapy with the VACStent-A pilot study to reduce anastomotic leakage after Ivor Lewis hybrid esophagectomy. Front Surg. 2023;10:1133083. doi: 10.3389/fsurg.2023.1133083.

Go To Front Surg.