Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks

Introduction: Management of esophageal anastomotic leaks (AL) and esophageal perforations (EP) remains difficult and often requires an interdisciplinary treatment modality. For primary endoscopic management, self-expanding metallic stent (SEMS) placement is often considered first-line therapy. Recently, endoscopic vacuum therapy (EVT) has emerged as an alternative or adjunct for management of these conditions. So far, data for EVT in the upper gastrointestinal-tract is restricted to single centre, non-randomized trials. No studies on optimal negative pressure application during EVT exist. The aim of our study is to describe our centre’s experience with low negative pressure (LNP) EVT for these indications over the past 5-years. Patients and Methods: Between January 2014 and December 2018, 30 patients were endoscopically treated for AL (n = 23) or EP (n = 7). All patients were primarily treated with EVT and LNP between –20 and –50 mm Hg. Additional endoscopic treatment was added when EVT failed. Procedural and peri-procedural data, as well as clinical outcomes including morbidity and mortality, were analysed. Results: Clinical successful endoscopic treatment of EP and AL was achieved in 83.3% (n = 25/30), with 73.3% success using EVT alone (n = 22/30). Mean treatment duration until leak closure was 16.1 days (range 2–58 days). Additional treatment modalities for complete leak resolution was necessary in 10% (n = 3/30), including SEMS placement and fibrin glue injection. Mean hospital stay for patients with EP was shorter with 33.7 days compared to AL with 54.4 days (p = 0.08). Estimated preoperative 10-year overall survival (Charlson comorbidity score) was 39.4% in patients with AL and 59.9% in patients with EP (p = 0.26). A mean of 5.1 EVT changes (range 1–12) was needed in EP and 3.6 changes (range 1–13) in AL to achieve complete closure, switch to other treatment modality, or reach endoscopic failure (p = 0.38). Conclusion: LNP EVT enables effective minimally – invasive endoluminal leak closure from anastomotic esophageal leaks and EP in high-morbid patients. In this study, EVT was combined with other endoscopic treatment options such as SEMS placement or fibrin glue injection in order to achieve leak or perforation closure in the vast majority of patients (83.3%). Low aspiration pressures led to slower but still sufficient clinical results

Effects of experimentally planting non-crop flowers into cabbage fields on the abundance and diversity of predators

Flowery field margins and intersowing of crops with flowers are used as management practices to promote arthropod biodiversity as well as biocontrol agents. Positive effects of enhancement (in abundance and species richness) of hymenopteran parasitoids on control of Lepidoptera pests have previously been demonstrated. However, effects on predatory arthropods, which may also serve as pest control agents, remain unclear. In an experimental study in cabbage fields we tested how sown flower strips on field margins and intersowing with cornflower affected the species richness, abundance and community composition of ground beetles and spiders. Furthermore, we investigated whether effects of flower margins are dependent on the distance from the field margins. We found that field margins generally harboured higher species richness, whereas effects on abundance were weaker. Intersown cornflower had positive effects on spider and ground beetle abundance, but affected species richness only weakly. Our results do not provide evidence for effects of distance from the flowery field margins on predator richness or abundance. Species composition was strongly affected by the habitat management actions. We conclude that habitat management practices like flower strips on field margins and intersowing with flowers, which are primarily added to attract and enhance parasitoids for pest control, also benefit biodiversity conservation in spiders and ground beetles. They also positively affect the abundance of these primarily predatory taxa, which adds to the biocontrol potential of non-crop flowering plants