Clinical implantation of 92 VACStents in the upper gastrointestinal tract of 50 patients-applicability and safety analysis of an innovative endoscopic concept

Introduction

Endoscopic vacuum therapy (EVT) has emerged as a promising treatment option for upper gastrointestinal wall defects, offering benefits such as evacuation of secretions and removal of wound debris by suction, and reduction and healing of wound cavities to improve clinical outcomes. In contrast, covered stents have a high rate of migration and lack functional drainage, while endoluminal EVT devices obstruct the GI tract. The VACStent is a novel device that combines the benefits of EVT and stent placement. Its design features a fully covered Nitinol-stent within a polyurethane sponge cylinder, enabling EVT while maintaining stent patency.

Methods

This study analyzes the pooled data from three different prospective study cohorts to assess the safe practicality of VACStent placement, complete leak coverage, and effective suction-treatment of esophageal leaks. By pooling the data, the study aims to provide a broader base for analysis.

Results

In total, trans-nasal derivation of the catheter, suction and drainage of secretion via vacuum pump were performed without any adversity. In the pooled study cohort of 92 VACStent applications, the mean stent indwelling time was 5.2 days (range 2-8 days) without any dislocation of the device. Removal of the VACStent was done without complication, in one case the sponge was lost but subsequently fully preserved. Minor local erosions and bleeding and one subsequent hemostasis were recorded unfrequently during withdrawal of the device (5.4%, 5/92) but no perforation or pressure ulcer. Despite a high heterogeneity regarding primary disease and pretreatments a cure rate of 76% (38/50 patients) could be achieved.

Discussion

In summary, insertion and release procedure was regarded as easy and simple with a low potential of dislocation. The VACStent was well tolerated by the patient while keeping the drainage function of the sponge achieving directly a wound closure by continuous suction and improving the healing process. The implantation of the VACStent provides a promising new procedure for improved clinical treatment in various indications of the upper gastrointestinal wall, which should be validated in larger clinical studies.Clinical Trial Registration: Identifier [DRKS00016048 and NCT04884334].

[Clinically relevant breath tests in gastroenterological diagnostics--recommendations of the German Society for Neurogastroenterology and Motility as well as the German Society for Digestive and Metabolic Diseases]

H (2)- and (13)C-breath tests are valuable non-invasive diagnostic tools for gastroenterological diseases. H (2)-breath tests are clinically established for the diagnosis of carbohydrate intolerance resulting from malabsorption (H (2)-breath tests with lactose, fructose, saccharose, sorbitol), of bacterial overgrowth (glucose H (2)-breath test) and for measurement of orcoceal transit time (lactulose H (2)-breath test). The (13)C-urea breath test is regarded as the "gold standard" procedure for the diagnosis of Helicobacter pylori infection. Moreover, (13)C-breath tests for measurement of gastric emptying can be considered as clinically established, meanwhile. (13)C-breath tests for the evaluation of pancreatic exocrine function or liver function can also be used clinically; however, they currently offer no substantial advantage over other diagnostic procedures. A major disadvantage of all breath tests is that they lack standardization although modifications of the test meal or solution, of the test performance and of the evaluation of data may markedly influence the results. Thus, this article presents the recommendations of the German Society of Neurogastroenterology and Motility and of the German Society of Digestive and Metabolic Diseases for clinically relevant H (2)- and (13)C-breath tests. Indications for the examinations, the procedures to be followed, the analysis of the obtained data and the conclusions to be drawn are delineated. The literature on which the recommendations are based is reviewed. However, personal experience of the authors is also taken into account since numerous questions regarding optimal test performance are not clarified by adequate studies.

[5-Fluorouracil-induced colitis--a review based upon consideration of 6 cases]

BACKGROUND

At increasing use of high-dose 5-fluorouracil-based chemotherapy for metastatic colorectal and gastric cancer complicated drug-induced colitis is observed more frequently. From May 1998 to November 2000 we observed 6 cases of 5-fluorouracil-induced colitis, in which we looked for involvement of small intestine. We report summing up on the 6 cases including both endoscopic and histological findings in both sites of the gut.

CASE REPORTS

In 2 men and 4 women (age 49-78 years) with advanced colon (n = 2), gastric (n = 3 ) and gallbladder (n = 1) cancer a palliative weekly high-dose infusional 5-fluorouracil (2,6 g/m(2)/24 h) and folinic acid (500 mg/m(2)/2 h) chemotherapy was performed. Few days after 1-5 chemotherapy courses the patients were admitted to our hospital with abdominal pain and partly severe watery diarrhea (up to 20 times evacuations/per day). The stool cultures were negative and there were no proof both of clostridium difficile and his toxin A and B. In 4 patients colonoscopy showed different grades of colitis up to diffuse erythema and microlesions, 2 patients had no visible lesions. In 4 patients endoscopy of the upper GI-tract showed a severe inflammation (n = 1) and a fibrinopurulent exsudate, severe edema and isolated ulcerations (n = 3) of jejunum after gastrectomy or duodenum with intact stomach. In the histological assessment different grades of 5-FU-induced colitis without (n = 2) or with (n = 4) involvement of the upper small intestine destruction of the superficial mucosa and crypts (epitheliumapoptosis) were found. 5 patients were treated by antibiotics (vancomycin n = 2, metronidazole n = 3), glucocorticoids (n = 5) and Saccaromyces cerevisiae (n = 3). After 8-10 days the patients were complete free of symptoms. One patient died due to the enterocolitis.

CONCLUSIONS

The present cases demonstrate that high-dose 5-fluorouracil-based chemotherapy not only induces a colitis but also may involve the upper small intestine tract. Consequently, it represents an increasing and serious adverse event of high-dose chemotherapy. The etiology of the enterocolitis (drug- or bacterial-induced) needs further investigations in order to find a causal therapy and/or prophylaxis.

[Treatment of acute peptic gastroduodenal ulcer: omeprazole is superior to ranitidine especially in the early phase of ulcer healing. A prospective controlled randomized serial endoscopy study]

Omeprazole (OM) has been shown to be superior to H2-Blockers in terms of complete healing rates of gastric (GU) and duodenal ulcers (DU). We investigated in more detail the kinetics of ulcer healing under OM (20 mg mane) compared with ranitidine (RAN 300 mg nocte) in GU (n = 28) and DU (n = 27) by multiple series endoscopy. After endoscopic diagnosis (day 0) patients were allocated to either OM or RAN in a random order. Endoscopic controls were undertaken at day (d) 3, 7, 14, 21, 28, 42 up to complete ulcer healing. The seize of ulcer areas was assessed by independent endocopists estimating the longest and shortest diameter D acc. to the formula A = pi x D1 x D2:4.

RESULTS

In GU and DU cumulating healing rates were sign, higher under OM. In GU and DU, the most striking differences in the absolute and percentual reduction of ulcer seize in favour of OM vs RAN were observed mainly during the first week. At d3 under OM the reduction in DU-area was 43% and at d7 75% compared to a distinctly lower rate under RAN with the corresponding figures of 9% and 61% resp. In GU the mean reduction in area was for IM at d3 41%, at d7 82% in contrast to RAN at d3 of 34% and d7 of 49%. The faster healing during the first week was accompanied by sign more rapid reduction in day-and-night-painscore during OM vs RAN.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of antirheumatic drug-induced ulcer in comparison with peptic gastroduodenal ulcer. Five-year analysis of a hospital patient sample]

Within the framework of a five-year analysis of a hospital population (n = 503), the epidemiological and diagnostic data of patients with non-steroidal anti-inflammatory drugs-associated ulcers of the stomach and duodenum (AIU) were evaluated and compared with those of patients with peptic ulcers (PUC) in the stomach and duodenum with no history of NSAIDs use. With respect to age and sex, patients with AIU were significantly older, in particular in the case of gastric ulcer, and revealed a predominance of female sex as compared with those with PU. Episodes of ulcer disease showed no seasonal dependence, either in the AIU or in the PU group. The use of tobacco and alcohol was comparable in both groups. Nor was any difference found between city and rural populations in either group. Laboratory data revealed a higher rate of pathological deviations in the AIU as compared with the PU group, which, however, was unequivocally due to the larger percentage of elderly patients in the former. With respect to blood group distribution, no differences were observed between the groups. An analysis of ulcer site showed a small preponderance of gastric ulcer (59%) over duodenal ulcer (41%) in the AIU group, while the distribution in the case of the PU group was virtually identical (gastric ulcer 51%, duodenal ulcer 49%), with only small differences in site within the stomach and duodenal bulb resp. Analysis of the risk indicators for ulcer bleeding (AIU 66%, PU 50%) revealed the following pattern: in the case of AIU, patients aged over 65, and in the case of AIU and PU, overweight males, bled significantly more often than, respectively, younger patients and female or normal-weight patients.(ABSTRACT TRUNCATED AT 250 WORDS)