CURRENT TREATMENT APPROACHES
- Treatment of defects of GI tract often involves surgical procedures aiming to either excise the site of injury or close the defect. More conservative approaches involve the use of stents (SEMS) covering the defect. Another commonly used approach, especially for chronic cases such as fistulas and anastomotic leaks, involves endoluminal vacuum therapy (EVT) when a device such as Eso-Sponge® or Endo-SPONGE® is placed endoscopically near or sometimes inside the site of injury and controlled negative pressure is applied to achieve active drainage and sanation of the injured site and promote its healing. The use of a foam (e.g. polyurethane) sponge with such devices is believed to improve the granulation of the wound and enhance the curative effect. More recently new device, VacStent GITM, has been introduced aiming to combine the benefits of EVT and covered stents.
- The disadvantage of all approaches involving EVT is that the negative pressure is applied in a relatively open environment and thus may not be as effective. Further, the site of injury remains accessible to the surrounding biofluids, which may further damage of infect it. EVT cannot be combined with delivery of medicines to the injured site. Feeding of patients would interfere with the action of standard EVT devices (but not VacStent GITM) and thus is impossible while they are used. Migration of devices, pulmonary aspiration related complications and necessity for multiple endoscopic procedures are among other disadvantages of the above methods.