Preemptive EVT is a further developtment of endoscopic vacuum therapy. It can be used beneficially to protect various gastrointestinal anastomoses.
Preemptive active reflux drainage (PARD) is a very simple and extremely effective new safety concept for esophageal surgery.
On this site you will find some clinical applikation examples and initial descriptions using open-pored film drains (OFD) for anastomosis prophylaxis in esophagus and in duodenum.
Anastomosis prophylaxis in Esophagus:
with the method of Pre-emptive active Reflux drainage (PARD):
Since 2017, we have been using the method of preemptive active reflux drainage (PARD) for anastomotic prophylaxis in all patients undergoing Ivor Lewis esophagectomy.
All patients undergoing Ivor Lewis resection suffer from postoperative reflux, which floods the anastomoses. The most important preventive goal of this simple method is to drain the aggressive digestive secretions of the reflux in order to avoid disrupting the healing of the anastomosis.
To completely empty the stomach, we use an innovative double-lumen drainage film with open pores (dOFD). This vacuum drainage is used postoperatively instead of a passive stomach drainage tube. An electronic vacuum pump is used to apply negative pressure to the drainage to empty the stomach tube and the anastomosis area. The special dOFD is manufactured using a Freka® Trelumina (Fresenius Kabi) and the Suprasorb® CNP drainage film (Lohmann & Rauscher).
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. The patient also receives enteral nutrition via the integrated feeding tube.
The following sections contain a detailed description of the PARD - method, instructions for manufacturing the special drainage tube using Freka® Trelumina (Fresenius Kabi) and the Suprasorb® CNP drainage film (Lohmann & Rauscher)., initial clinical reports from retrospective studies, and presentations.
We use this double-lumen open-pore film drain (dOFD) for PARD in Ivor-Lewis Esophagoectomy.
This innovative drainage system enables simultaneous feeding via an enteral feeding tube and complete active drainage of gastric secretions via a drainage leg to which negative pressure is applied.
The drainage system is not yet available as a medically approved product. It must still be manufactured by the user. The responsibility for its use on patients therefore lies exclusively with the user.
The following sections with videos show you how easy it is to manufacture the drainage system.
"It could be said that an
OFD (Drainagetube Freka® Trelumina (Fresenius Kabi) covered with the Suprasorb® CNP drainage film (Lohmann & Rauscher)
is like an NGT, but with the additional benefit that suction can be applied."
First casereport presenting the method of prevention The Gastric reflux with EVT
Prevention of reflux after esophagectomy (PDF) with endoscopic negative pressure therapy usind a new double lumen open-pore film drainage with an intestinal feeding tube. Loske G et al. Endoscopy 2017
Video demonstrates the construction of a double-lumen open-pore film drainage (OFD) device and the course of endoscopic negative pressure therapy (ENPT) for preventing gastric reflux after Ivor Lewis esophagoectomy.T
First clinical report on a series of patients undergoing prophylactic use of double-lumen open-pored film drainage following Ivor Lewis esophagectomy published in Surgical Endoscopy
With the PARD method, gastric reflux is completely drained using vacuum drainage, and the anastomosis is decompressed. At the same time, complete enteral nutrition is provided via the feeding tube.
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). Loske G et al. Surg Endosc. 2022
Schematic illustration of the PARD method
Video demonstrates the construction of a dOFD
Second clinical report on a series of 43 patients undergoing prophylactic use of double-lumen open-pored film drainage following Ivor Lewis esophagectomy published in Die Chirurgie
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.
Loske G et al. Chirurgie 2025
The figure illustrates the principle of prophylaxis with a dOFD: simultaneous nutrition, decompression, and reflux elimination with a drainage film (Suprasorb® CNP Drainage Film (Lohmann&Rauscher)) coated Freka® Trelumina (Fresenius Kabi). A continuous vacuum suction is applied to the drainage using an electronic pump.
dOFD - an innovative Tool for Ivor Lewis anastomosis prophylaxis
The innovative dOFD for anastomosis prophylaxis is made by using a Freka® Trelumina (Fresenius Kabi) and the Suprasorb® CNP Drainage Film (Lohmann&Rauscher).
Lecture AT ÖCK Salzburg 2024: PARD - new safety concept for the esophagus
Short lecture at the VisceralMedicine congress in Hamburg 2022
Pre-emptive aktive Refluxdrainage (PARD) und simultane enterale Ernährung mit einer doppellumigen offenporigen Foliendrainage und intraluminaler endoskopischer Unterdrucktherapie – eine neue einfache Methode zur Anastomosen- und Aspirationsprophylaxe bei abdomino-thorakaler Ösophagusresektion
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.
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.
Anastomosis prophylaxis in Duodenum:
We also use this double-lumen open-pored film drain (dOFD) for preemptive EVT in the duodenum.
The method is presented in two initial case reports.
First casereport:
Presentation of a new preemptive endoscopic treatment concept in duodenal interventions exemplified by an iatrogenic duodenal perforation after percutaneous transrenal nephrostomy.
V. Betz, A. Goerdt, R. Kiesow, J. Müller, B. Riefel, E. Scharsack, U. Zimmermann, M. Reeh & G. Loske Chirurgie 2025
In the second case report, we show how we used the preemptive method in a duodenal resection.
Here, the drainage is placed in the operative-endoscopic rendezvous maneuver.
In the video we demonstrate the manufacturing of the dOFD Drainage with a triluminal tube (Fresenius Kabi) and the Suprasorb CNP Drainagefilm (Lohmann&Rauscher). And we demonstrate the operative and endoscopic handling in detail.
Good teamwork between the endoscopist and surgeon is important in this case.
Preemptive Intraluminal Negative Pressure Therapy (PINPT) for Duodenal Resection Using a Double Lumen Open-Pore Film Drain (dOFD) – First Report of a New Method for Anastomotic Prophylaxis in Duodenum
Loske G et al. . IJCMCR. 2025
The image illustrates the principle of anastomosis prophylaxis. Vacuum drainage (NP) is used to continuously drain and decompress the duodenum in the anastomosis (A). At the same time, nutrition is provided via the feeding tube (iT).
In the last section, we show the use of open-cell foam drainage for anastomosis prophylaxis. We demonstrate the technique again in two of the very first case reports.
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.
Loske G et al. Endoscopy. 2014
