Prevention of reflux after esophagectomy with endoscopic negative pressure therapy using a new double-lumen open-pore film drainage with an intestinal feeding tube.

Reflux after Ivor Lewis esophagectomy has a deleterious effect on anastomotic wound healing and is a risk for pulmonary aspiration [1]. We report endoscopic negative pressure therapy, using a novel double-lumen open-pore film drainage method, for prevention of postoperative reflux. A 70-year-old patient underwent Ivor Lewis esophagectomy because of carcinoma of the distal esophagus (pT2pN0), having undergone laryngectomy because of carcinoma of the larynx 5 years previously. On postoperative day 4, rising inflammatory parameters led to endoscopy in order to check the anastomosis, in accordance with our treatment algorithm [2]. We found biliary gastric reflux flooding the intrathoracic anastomosis (▶Fig. 1). The anastomotic tissue was seen to be green-colored and the staple line of the stomach showed signs of inflammation (▶Fig. 2). We decided to evacuate the stomach with endoscopic negative pressure therapy, using an innovative double-lumen drainage system that incorporated open-pore film material. Our goal was to eliminate the postoperative reflux that was compromising the anastomotic healing. We adapted a triluminal tube (Freka Trelumina, CH/Fr 16/9, 150 cm; Fresenius, Germany) using open-pore film (Suprasorb CNP Drainagefolie; Lohmann and Rauscher, Germany). All the openings of the gastric channel of the triluminal tube were wrapped around once with a length of the open-pore film. The film was fixed using suture thread. The ventilation lumen of the tube was blocked with a clamp (▶Fig. 3, ▶Video1). The small-bore tube was inserted nasally and pushed, so that finally the intestinal feeding channel was positioned in the duodenum (▶Video1) and the filmwrapped part of the tube was positioned in the stomach (▶Fig. 4). Application of negative pressure with an electronic device (setting – 125mmHg, continuous, intensity 10; KCI V.A.C. Freedome, KCI USA Inc., San Antonio, Texas, ▶ Fig. 1 Biliary gastric reflux (Rf) is flooding the anastomosis in the esophagus (Eso) of a 70-year-old patient who has undergone Ivor Lewis esophagectomy. ▶ Fig. 2 Retroverted view shows the green-colored anastomosis (A), inflammation at the gastric staple line (Stl), and the endoscope (E). ▶ Fig. 3 Double-lumen open-pore film drainage (OFD) device with intestinal feeding channel (IC), adapted from a triluminal tube by means of open-pore film (oF). The (ventilation) lumen (V) is blocked with a clamp (bl).