Preemptive EVT is a further development of endoscopic negative pressure therapy. It can be used beneficially to protect various anastomoses. The intraluminal version of the therapy is used. For intraluminal EVT, the open-pore drain is placed in the lumen of the bowel. Both porous foam and film drains can be used. Here you will find some application examples and initial descriptions.
Method of Pre-emptive active Reflux drainage (PARD):
Since 2017, we have been using a double-lumen open pore drainage (dOFD) with a simultaneous enteral feeding channel, to which we apply an active negative pressure, instead of a passive gastric drainage tube in pre-emptive intention for all patients undergoing an Ivor-Lewis oesophagectomy.
With this new dOFD drainage device, we completely empty the stomach immediately after suturing the anastomosis. At the same time, the gastric tube is decompressed. At the same time, the patient receives enteral nutrition via the integrated feeding tube.
Our aim is to drain the aggressive digestive secretions of the reflux in order to avoid disrupting the healing of the anastomosis.
Vortrag: PARD - neues Sicherheitskonzept Ösophagus auf dem ÖCK 2024, Salzburg, Abstrakt 08.5.
Description of the PARD method as a new safety concept for oesophageal surgery
Loske G, Müller J, Schulze W, Riefel B, Reeh M, Müller CT.
Endoskopische Unterdrucktherapie : Vom Komplikationsmanagement zur präemptiven aktiven Refluxdrainage bei abdomino-thorakaler Ösophagusresektion – ein neues Sicherheitskonzept für die Ösophaguschirurgie Chirurgie (Heidelb). 2023 Dec;94(12):1022-1033. German. doi: 10.1007/s00104-023-01970-2. Epub 2023 Oct 26. PMID: 37882839; PMCID: PMC10689535. of print. PMID: 38085297.
Original publication on the PARD method first published in Surgical Endoscopy
Loske G, Müller J, Schulze W, Riefel B, Müller CT.
Pre-emptive active drainage of reflux (PARD) in Ivor-Lewis oesophagectomy with negative pressure and simultaneous enteral nutrition using a double-lumen open-pore film drain (dOFD). Surg Endosc. 2022 Mar;36(3):2208-2216.
doi: 10.1007/s00464-021-08933-w. Epub 2022 Jan 1. PMID: 34973079; PMCID: PMC8847238.
Pre-emptive ENPT in Esophagus after Ivor-Lewis Esophagoectomy
Short lecture at the congress Visceral Medicine 2022 in Hamburg, September 2022
Beschreibung der PARD-Methode als ein neues Sicherheitskonzept für die Ösophaguschirurgie
Loske G, Müller J, Schulze W, Riefel B, Reeh M, Müller CT. Endoscopic negative-pressure treatment : From management of complications to pre-emptive active reflux drainage in abdomino-thoracic esophageal resection-A new safety concept for esophageal surgery. Chirurgie (Heidelb). 2023 Dec 12. English. doi: 10.1007/s00104-023-01996-6. Epub ahead of print. PMID: 38085297.
Schematic representation of the method of pre-emptive active reflux drainage (PARD) in Ivor-Lewis esophagectomy from a presentation at the MIC Symposium Hamburg in November 2021.
We use this double-lumen open-pore film drain (dOFD) for PARD in Ivor-Lewis Esophagoectomy.
Making of a double-lumen open-pore film drain (dOFD) for pre-emptive active reflux drainage (PARD) with simultanous enteral feeding in cases of Ivor-Lewis esophagoectomy is demonstrated in video.
Video demonstrates the making of a double-lumen open-pore drain (dOFD) for pre-emptive reflux drainage after Ivor-Lewis esophagectomy. The drainage allows active aspiration of post-operative reflux (PARD) with simultaneous enteral feeding via an integrated feeding tube in the vulnerable early operative phase. PARD with open-pore drainage serves to prevent postoperative anastomotic insufficiency and increases patient safety during this high-risk surgery.
Das Video demonstriert die Herstellung einer doppellumigen offenporigen Drainage (dOFD) für die pre-emptive Refluxdrainage nach Ivor-Lewis Ösophagusresektion. Die Drainage ermöglicht die aktive Absaugung des postoperativen Refluxes (PARD) bei gleichzeitiger enteraler Ernährung über eine integrierte Ernährungssonde in der vulnerablen frühoperativen Phase. Die PARD mit offenporigen Drainage dient der Vermeidung der postoperativen Anastomoseninsuffizienz und erhöht die Patientensicherheit bei dieser Hochrisikooperation.
Prevention of reflux after esophagectomy with endoscopic negative pressure therapy using a new double-lumen open-pore film drainage with an intestinal feeding tube
Loske G, Schorsch T, Müller CT. Prevention of reflux after esophagectomy with endoscopic negative pressure therapy using a new double-lumen open-pore film drainage with an intestinal feeding tube. Endoscopy. 2017 Dec;49(12):E294-E295. doi: 10.1055/s-0043-118211. Epub 2017 Sep 19. PMID: 28926851.
First Report of Intraluminal Endoscopic Negative Pressure Therapy (ENPT) for Anastomotic Prophylaxis in a Case of Tubular Resection of Cervial Esophagus
Intraluminal endoscopic vacuum therapy in a case of ischemia of the blind end of the jejunal loop after Roux-en-Y gastrectomy
Loske G, Schorsch T, Schmidt-Seithe H, Müller C. Intraluminal endoscopic vacuum therapy in a case of ischemia of the blind end of the jejunal loop after Roux-en-Y gastrectomy. Endoscopy. 2014;46 Suppl 1 UCTN:E575-6. doi: 10.1055/s-0034-1390913. Epub 2014 Nov 21. PMID: 25415175.
