Endoscopic negative-pressure therapy for duodenal leakage using new open-pore film and polyurethane foam drains with the pull-through technique.

Few reports have described the use of endoscopic vacuum therapy (EVT) for duodenal defects [1–4]. We treated a complicated duodenal leak with EVT using the pull-through technique with a new type of open-pore polyurethanefoam drain (OPD) [5] and a novel type of open-pore film drain (OFD). Construction of an OFD is shown in ▶Video1. First the distal ends of two drainage tubes (Ventrol; 12–18Fr × 120cm; Covidien, Argyle, Ireland) are connected. This coupling segment is then wrapped with open-pore polyurethane-foam or a very thin double-layered film (Suprasorb CNP drainage film; Lohmann & Rauscher, Germany) (▶Fig. 1). The diameter of the OPD is 1.5–3 cm and of the small-bore OFD is 4–6mm (▶Fig. 2). Both drain types can be placed by the pull-through technique along an intestinal–cutaneous fistula. The oral end is passed out nasally and a vacuum is applied to drain the intraluminal secretions; the distal end is passed out cutaneously (▶Fig. 3). We report a 53-year-old patient who presented for endoscopic examination with a persisting duodenocutaneous fistula after a very complicated course including multiple operations. Duodenal secretions were running along an intraabdominal drain placed next to the duodenum and a 2-cm transmural defect of the duodenal wall was found near to the papilla of Vater. The operative drain could be seen through this defect. An OPD was inserted using the pullthrough technique following the course of the operative drain. The foam was pulled into the internal opening of the duodenal fistula. Application of negative pressure with an electronic vacuum device (KCI Activac; setting 125mmHg, continuous, intensity high) resulted simultaneously in closure of the defect around the tube, collapse of the duodenal lumen, and internal drainage of duodenal secretions. The drainage of secretions cutaneously stopped immediately. Video 1 Construction of an open-pore film drain (OFD) for the pull-through method is demonstrated. Different types of pull-through drains are illustrated. Insertion of an openpore polyurethane-foam drain (OPD) is shown using the pull-through technique in a patient with duodenal leakage.