- Incorrect placement of the stent
Since it is a distal release system, it is better to tend to place the stent more distally. Retracting an inserted stent is easier than pushing it further inward. The circular wire at the proximal, thickened end is grasped with the endoscopic grasping forceps and simply pulled because this action reduces the stent diameter. The same technical mechanism is used in the extraction of the device.
- Incomplete expansion of the stent (the inner diameter of the stent body has not fully expanded to 14 mm):
This can be remedied by pneumatic balloon dilation, also to ensure the possibility of oral food intake.
- Worsening of the defect by the endoscope
- Aspiration during VAC-stent procedures
endobronchial lavage and suction to prevent pneumonia
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Interventional
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Post-interventional
- Obstruction of the drainage tube/VAC stents:
If a VAC stent is obstructed, adequate vacuum and drainage cannot be ensured.
- Dysphagia:
Swallowing may be somewhat impaired as the stent blocks the active peristaltic wave along the entire length of the stent, so the transport of food over this distance occurs only passively. In most cases, the passage slows down slightly but remains possible.
- Malfunction of the drainage capacity of the VAC stent due to pump dysfunction
- Dislocation of the VAC stent/inadequate sealing
- e.g., sponge dislocation orally due to accidental pull on the drainage tube
- Imaging via CT scan with oral contrast if there is doubt about adequate treatment and to check if the cavity around the stent has collapsed and is sufficiently sealed by the stent.
- If the canister fills quickly, stent dislocation should be considered, as this may indicate gastric fluid or tube feeding.
- Tissue ingrowth:
If the VAC stent is not regularly loosened, ingrowth could cause damage to the surrounding tissue. For this reason, the sponge must be changed at least once a week.
- Incomplete stent removal:
Either due to ingrowth of esophageal tissue into the sponge or due to lack of fixation between the sponge and stent body, causing the sponge to adhere to the esophageal wall and requiring separate mobilization for removal.
- Erosion/ulcer formation at the stent site after removal:
These erosions or ulcers have not yet led to perforations or bleeding requiring intervention.
- Anastomotic/esophageal stricture:
- An esophageal stenosis with clinical dysphagia is a potential complication as a long-term consequence of endoluminal EVT and possibly VAC stent therapy.
- Treatment through endoscopic dilations and, if necessary, incision therapy.
- Gastroesophageal reflux:
If the gastroesophageal junction is bridged by the stent, this can cause nausea and esophagitis, which can be treated with proton pump inhibitors.
- Severe therapy-associated complications
have not been described to date. Possible risks include bleeding due to vascular erosions and the formation of esophagobronchial fistulas, which have been described in individual cases in EVT therapy and are also conceivable for the VAC stent.
- Obstruction of the drainage tube/VAC stents: