Endoscopic Vacuum Therapy for Duodenal Hemorrhage in Critically Ill Patients With COVID-19

• Published in: The American journal of gastroenterology Vol. 117; no. 4; p. 688
• Main Authors: de Moura, Diogo T H, de Moura, Eduardo G H, Hirsch, Bruno S, McCarty, Thomas R, Rodela Silva, Gustavo L, Rizk, Stéphanie I, Thompson, Christopher C, Hoff, Paulo M, Hajjar, Ludhmila A
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.04.2022
• Subjects: Coronaviruses; COVID-19; Critical Illness - therapy; Duodenal Diseases; Endoscopy; Extracorporeal membrane oxygenation; Gastroenterology; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hemorrhage; Humans; Laboratories; Negative-Pressure Wound Therapy; Patients
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000001643

EVT-related mechanisms including macrodeformation, microdeformation, changes in perfusion, exudate control, and gastric and biliopancreatic secretions clearance promote healing and may also be adapted for the treatment of refractory hemorrhage (4,5). [...]we applied these principles of EVT in 3 patients with COVID-19 on ECMO support and diffuse duodenal hemorrhage refractory to conventional endoscopic hemostatic therapies. [...]the device was connected to a vacuum machine (−125 mm Hg). Initial esophagogastroduodenoscopy demonstrated duodenal villous atrophy associated with diffuse bleeding, including active ulcers and visible vessels. [...]a modified EVT was performed.Table 1.