Evaluation of canal patency and cleanliness following retreatment of bioceramic sealer-obturated root canals using three different irrigant activation protocols.

This study evaluated the effectiveness of three different irrigant activation techniques in cleaning and establishing patency during retreatment of root canals obturated with gutta-percha and bioceramic sealer. 60 extracted premolars with oval-shaped canals were instrumented and obturated with gutta-percha and EndosequenceBC sealer using the 'warm hydraulic condensation' technique. The teeth were retreated using Protaper Universal Retreatment and XP-Endo Shaper system and divided into four groups according to the irrigant activation protocol used: control, passive ultrasonic irrigation (PUI), Endovac irrigation (EVI) and XP-Endo Finisher R (XPFR). Apical patency was achieved in all the samples of the XPFR group (100%), which showed a significantly higher success rate compared with the control (73.3%) and EVI groups (73.3%) (p < 0.05). The scanning electron microscopic evaluation revealed significantly cleaner middle and apical third root canals in the PUI and XPFR groups compared with the control group (p < 0.05). These findings suggest that XPFR effectively cleans and establishes patency in root canals filled with bioceramic sealers.

Conventional to EndoVac: A Comparative Evaluation of Two Irrigation Systems in Microbial Reduction of Primary Root Canals Using Chemical Irrigants: An In Vivo Study.

Purpose: The purpose of this in vivo study was to compare the relative efficacy of two different chemical irrigants in achieving the same objective of bacteria decrease in deciduous teeth. The classic needle irrigation system and the EndoVac system were chemical irrigants. Materials and methods: In this comparative study, 80 deciduous molars in patients aged 3-9 years were chosen according to the selection criteria. The teeth were divided randomly into four groups based on the irrigation system and irrigant used, namely, the group I [2.5% sodium hypochlorite (NaOCl) + conventional needle], group II (2.5% NaOCl + EndoVac), group III [2% chlorhexidine (CHX) + conventional needle], and group IV (2% CHX + EndoVac). Pre and postirrigation microbial samples were collected and transferred for microbial assay. Thereafter, pre and postoperative observations were recorded and a mean reduction of bacterial colony-forming units (CFU)/mL was obtained. The statistical analysis was then performed. Results: In the intragroup comparison, EndoVac and the conventional system showed a statistically significant (p > 0.05) reduction in mean CFU/mL. In the intergroup comparison, EndoVac showed better results than the conventional needle irrigation system (p > 0.05). There was more reduction in CFU in 2% CHX than in 2.5% NaOCl in both the conventional needle system (p = 0.3056) and the EndoVac system (p = 0.4573), with no significant difference. Conclusion: In this in vivo study, the efficacy of EndoVac was found to be better among all the tested groups. Around 2% CHX was found superior as compared to 2.5% NaOCl with no significant difference. Clinical significance: The EndoVac apical negative pressure irrigant system eliminates optimum bacterial load. It significantly cleans more debris from mechanically inaccessible regions of root canals. The use of 2% CHX has shown promising results due to its property of substantivity and acceptability by children. How to cite this article: Ahmadi M, Govil S. Conventional to EndoVac: A Comparative Evaluation of Two Irrigation Systems in Microbial Reduction of Primary Root Canals Using Chemical Irrigants: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(S-2):S113-S117.

Efficacy of Three Irrigation Methods in Removing Calcium Hydroxide from Curved Root Canals: An In Vitro Micro-CT Study.

Aims and Objectives: This in vitro study aimed to compare the efficacy of three different irrigation methods in removing calcium hydroxide from curved root canals and to estimate the amount of residual medicament using microcomputed tomography. Materials and Methods: Thirty extracted molars with curved mesial root canals, ranging from 25° to 30°, were prepared with ProTaper Next using X2 to full working length and were filled with calcium hydroxide. Teeth also were randomly divided into four groups: group 1 (n = 8)- Erbium: Yttrium-Aluminum-Garnet (Er:YAG) laser; group 2 (n = 8)-EndoActivator; group 3 (n = 8)-EndoVac; and a control group (n = 6)-negative control with no calcium hydroxide. Microcomputed tomography was used to evaluate the residual amount of filling material. Statistical analysis was performed using IBM SPSS Statistics 26, with a significance level of 0.05. Descriptive statistics, student t test, and Chi-square test were applied for data analysis. Results: The greatest amount of residual calcium hydroxide was observed in the samples with EndoVac irrigation (0.515 mm3), followed by EndoActivator (0.381 mm3) and Er:YAG laser (0.121 mm3). However, no statistically significant difference was observed between the groups. The greatest residual amount was observed in the apical third (0.419 mm3), followed by the middle (0.050 mm3) and the coronal (0.015 mm3). Conclusions: No statistically significant differences were observed in the efficacy of the tested techniques for removing calcium hydroxide from curved root canals, whereas a significant difference was observed in the distribution of residual material depending on the technique used. The removal of the calcium hydroxide was more effective in the coronal and middle third of the canal. The greatest residual material was found in the apical portion of the root canal.

Comparative evaluation of four different root canal irrigation techniques for apical extrusion of sodium hypochlorite - An in vitro study.

Objective: This study compared the potential for apical extrusion of sodium hypochlorite (NaOCl) when using needle irrigation (NI), passive ultrasonic irrigation (PUI), passive subsonic irrigation (PSI), and negative pressure system (NP). Materials and Methods: One hundred freshly extracted human permanent anterior teeth with complete root formation were embedded rigidly in agarose gel-containing cresol purple. Teeth were randomly allocated to six groups: G1-NI; G2-PUI; G3-PSI; G4-NP; G5-positive control; and G6-negative control. The chemomechanical preparation was completed and 12 ml of 3% NaOCl was delivered for 180 s in all groups. Dye diffusion was standardized by doing gel photography after the NaOCl final irrigation the Chi-square test and Kruskal-Wallis one-way analysis of variance test were used for the data analysis. Results: G1 had statistically significant apical extrusion compared to G2 (P = 0.001), G3 (P = 0.001), and G4 (P = 0.001) groups. G4 showed the least amount of apical extrusion. Conclusions: pH-sensitive gel model is useful in evaluating NaOCl extrusion. NP produced least NaOCl extrusion as compared to the other three systems. Due consideration should be given to the potential for apical extrusion of the irrigant before the selection of an irrigation system.

Comparative Evaluation of Different Irrigant Agitating Devices for Debris Removal from the Mesial Roots of Mandibular Molars: An In Vitro Study.

AIM: To evaluate the efficiency of debris removal from the mesial root canals and isthmus of mesial roots of mandibular molars after final irrigant agitation with XP-endo Shaper, EndoVac (EV), plastic finishing file, and conventional needle irrigation. METHODS AND MATERIALS: Forty extracted human mandibular first molar teeth with the isthmus between the mesial roots were selected, access cavities were prepared and distal roots were decoronated. All the mesial root specimens were mounted in acrylic, sectioned at the coronal, middle, and apical thirds, along with the resin block, and examined for debris in the canals and isthmus before the start of the procedure using a stereomicroscope and were mounted back in a custom-made jig. After determination of the working length, they were allocated to the following four different irrigant activation groups (n = 10): Group I-XP-endo Finisher; group II-EndoVac; group III-plastic finishing file; and group IV-standard needle irrigation. After biomechanical preparation (BMP) till F3, final agitation was done for debris removal with the respective agitating devices, and all the samples were examined under a stereomicroscope for the amount of debris in the canal after final agitation. RESULTS: Of all the irrigation devices used, the XP-endo Finisher and EV showed more debris removal when compared to other groups (p < 0.05). The plastic finishing file in continuous rotation was more efficient in cleaning debris compared with conventional needle irrigation (p < 0.05). CONCLUSION: The XP-endo Finisher and EV showed a significant difference in cleaning efficacy than the plastic finishing files. So, these can be used as adjunctive for agitating the final irrigant. CLINICAL SIGNIFICANCE: The irrigant agitation devices promote the penetration of irrigants into the intricate root canal anatomy and increase their antibacterial and tissue-dissolving effectiveness thereby improving the success rate and treatment outcome.

Positive Pressure and Negative Pressure Irrigation Dynamics with Different Needle Designs Using Computational Fluid Dynamics

@#This study aimed to investigate the irrigation dynamics of the positive pressure side-vented (SV) needle, EndoVac (micropores) needle and modified apical negative pressure (mANP) open-ended needle using computational fluid dynamics (CFD). A simulation of a prepared root canal (conical frustum) of 15 mm length with an apical diameter of 0.40 mm following Protaper F4 apical preparation was created using three-dimensional (3D) CAD software. The 3D simulated needle of SV 30G needle, EndoVac with micropores needle and mANP, 30G flat open-ended needle were also created. The irrigation dynamics were evaluated through transient CFD simulations. In addition, the irrigation dynamics of mANP at 0.2 mm, 0.5 mm, and 1.0 mm short from the working length were also assessed. The EndoVac and mANP showed negative apical static pressure and streamline patterns able to reach the apical region, thus indicating negligible extrusion. Meanwhile, SV showed positive apical static pressure and almost nonexistent streamlines beyond the needle tip. The SV showed the highest wall shear stress (WSS) magnitude of 1030Pa whereas Endovac (161 Pa) and mANP1 (258 Pa). However, SV revealed lower average WSS (10 Pa) compared to mANP1 (13 Pa) and mANP2 (11 Pa). This is due to SV developed a localised maximum WSS opposite the open vent area only therefore, uneven distribution of WSS. The EndoVac system developed a localised maximum WSS in the pair of micropores furthest away from the apical. CFD analysis of the EndoVac, mANP and SV showed different technique approach, needle design and needle depths insertion affect the irrigation dynamics pattern and magnitude.

Management of symptomatic irreversible pulpitis using irrigation agitation techniques in anterior teeth.

Endodontic pain, a common complication after root canal treatment, affects 2.5% to 60% of patients. Therefore, it is of interest to compare apical negative pressure irrigation (EndoVac) with conventional needle irrigation to assess their impact on postoperative pain in permanent anterior teeth with symptomatic irreversible pulpitis. Fifty patients were randomly assigned to either the EndoVac or needle irrigation group. Pre and post-operative pain levels were assessed using a Visual Analog Scale and the amount of Ibuprofen taken was recorded. At 12-, 24-, and 48-hour intervals, the EndoVac group reported significantly less pain than the needle irrigation group. The needle irrigation group also required more Ibuprofen. The apical negative pressure irrigation system (EndoVac) resulted in significantly less postoperative pain and reduced the need for analgesic medication than the conventional needle irrigation protocol.

Outpatient closure in a late colo-cutaneous postoperative anastomotic leak managed with EVAC in Bucaramanga, Colombia. Case report.

INTRODUCTION: After Hartmann-type colostomy, the adequate selection of some patients allows reversal and closure of the colostomy, however, this reversal is not free of complications. Among complications, anastomotic leaks and fistulae can have functional, economic, and oncological consequences. Complications have been treated with surgery; yet, this management has changed considerably in recent years, moving towards less invasive therapies. PRESENTATION OF CASE: This is the report of a 42-year-old man with a history of closed abdominal trauma with perforation of the sigmoid colon managed with a Hartmann-type colostomy. Six months later, he was admitted for a Hartmann reversal procedure without immediate complications. He was assessed again after 4 months observing a small area of erythema and periumbilical edema. EUS was performed without evidence of collections. Colonoscopy evidenced a 7-mm fistulous orifice in the colocolonic anastomosis. The Endo-VAC system was used, performing endoscopically exchanges twice a week following a low-residue diet. The procedure was performed on an outpatient basis and the closure of the leak hole in the colonic anastomosis was achieved in 30 days. DISCUSSION: Endoluminal vacuum therapy or EVAC, is an adaptation of the therapy used for negative pressure wound closure. This minimally invasive technique has been used for the treatment of gastrointestinal leaks and fistulae in selected patients and within a hospital setting. Our case presents the use of this technique in a late colocutaneous postoperative leak on an outpatient basis. CONCLUSION: To the best of our knowledge we report the first case of a late colocutaneous anastomotic leak managed with EVAC on an outpatient basis.

Comparative evaluation of antimicrobial efficacy on Enterococcus faecalis and smear layer removal in curved canals by different irrigation techniques: An in vitro study.

Background: Various irrigation techniques have been proposed to improve the effectiveness of root canal debridement. Aims: The aim of the study was to compare the antimicrobial effect on Enterococcus faecalis and smear layer removal efficacy in curved canals by different irrigation techniques. Materials and Methods: Eighty extracted permanent maxillary molars with curved mesiobuccal roots were inoculated with E. faecalis. The tooth samples were then divided into four groups: Group A - EndoVac, Group B - Passive Ultrasonic Irrigation (PUI), Group C - Photodynamic Therapy (PDT), and Group D - Laser Irrigation with Photon-Induced Photoacoustic Streaming (PIPS). The percentage of bacterial reduction was calculated. The presence of smear layer from coronal, middle, and apical sections was evaluated through scanning electron microscopy. Statistical Analysis: Statistical analysis was performed using Kruskal-Wallis test. Intergroup comparison was made with Mann-Whitney U-test. Results: Although statistically insignificant, the irrigation techniques have shown considerable reduction in E. faecalis biofilm (P > 0.05). EndoVac, PUI, and PIPS have shown significantly higher efficacy in removing smear layer from apical third than PDT (P < 0.001). Conclusion: The newer PIPS technology can be used as an efficient tool in the decontamination of root canals. However, more clinical studies in this aspect are required to ensure more thorough debridement and disinfection of the root canal system.

The Etiology, Diagnosis, and Management of Esophageal Perforation.

BACKGROUND: Esophageal perforation is a serious and potentially life-threatening medical emergency. Given multiple etiologies and varying clinical presentations of the perforated esophagus, the diagnosis is commonly delayed, complicating expeditious and optimal intervention. METHODS: We thoroughly reviewed the latest literature on the subject and herein describe the various treatment strategies in varying settings. RESULTS: Treatment depends on multiple factors including the cause and location of the perforation, the time interval between the inciting event and presentation to the managing clinician, the overall medical stability of the patient, comorbidities including pre-existent esophageal pathology or prior foregut operations, and both the location and extent of extra-esophageal fluid collections. Because of these various considerations, determining the best diagnostic and therapeutic approach requires considerable clinical experience and judgment on the part of the physician. Management principles include (1) adequate fluid resuscitation; (2) expeditious administration of appropriate broad-spectrum antibiotics; (3) repair, occlusion, exclusion, diversion, or exteriorization of the perforation site; (4) drainage of extraluminal fluid collections; (5) relief of distal obstruction; and (6) nutritional support. CONCLUSIONS: For decades, operative intervention has been the mainstay of therapy for esophageal perforation. More recently, endoscopic therapies, including stenting, clipping, suturing, or endoscopic vacuum therapy, have been introduced, expanding the clinician's therapeutic armamentarium while supplanting surgical approaches in many cases. With further experience and introduction of novel therapies, the management of esophageal perforation undoubtedly will continue to evolve.

Comparative evaluation of different irrigating and irrigant activation system in removal of gutta-percha/sealer during retreatment: An in vitro Micro-CT study.

Background: The aim of the study was to compare the efficacy of different irrigation and irrigant activation system used as an adjuvant to retreatment rotary files in removal of gutta-percha and sealer from endodontic retreatment using Micro-CT. Method: 64 extracted permanent maxillary central incisor teeth with single canal, were collected and decoronated to standard length of 16 mm. Instrumentation was done using rotary files and obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed using ProTaper universal retreatment files (D1, D2, D3). All 64 sample were randomised into four groups (n = 16) Group1: Endodontic syringe irrigation, Group 2: Passive Ultasonic Irrigation (PUI), Group 3: EndoActivator, and Group 4: EndoVac. Micro-CT scanning was performed after obturation, initial removal of filling material by retreatment file and after using experimental protocols of each group, and volume of remaining filling material was calculated using Dolphin software. Statistical analysis performed with one-way ANOVA followed by Tukey's post hoc. Results: A significant reduction in the volume of residual obturation material were found between each group. PUI was superior to the sonic (EndoActivator), negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle third and apical third of the root canal. However, none of the supplementary techniques were able to completely remove the residual obturation material. Conclusion: PUI and EndoActivator were found better in remaining filling material removal, demonstrating clinically useful as supplementary technique in removing remaining obturation material during endodontic retreatment.

Effectiveness of Different Irrigant Activation Systems on Smear Layer Removal: A Scanning Electron Microscopic Study.

The aim of this study was to evaluate the effectiveness of smear layer removal after the use of different irrigation methods (passive ultrasonic irrigation (PUI), continuous ultrasonic irrigation (CUI), apical negative pressure irrigation and conventional irrigation) using scanning electron microscopy (SEM) as an analytical tool. A total of 100 single-canal teeth were decoronated and randomly divided into five groups (n = 20) according to the irrigation method used: conventional irrigation with front outlet syringe, conventional irrigation with lateral outlet syringe, apical negative pressure irrigation (EndoVac), PUI with Irrisafe and CUI with ProUltra PiezoFlow ultrasonic irrigation needle. Root canal preparation was performed with the ProTaper Gold system up to the F4 instrument, and 5.25% NaOCl was used as an irrigant. After chemical-mechanical preparation, the roots were split longitudinally, and the coronal, middle and apical thirds were examined. SEM digital photomicrographs were taken at ×1000 magnification to evaluate the amount of smear layer in each root canal third; CUI significantly removed more smear layer than any other irrigant activation protocol (p < 0.05); CUI was more effective in removing the smear layer than the other irrigation protocols. However, none of the irrigation protocols were able to produce root canals completely free from smear layer.

Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks.

BACKGROUND: Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks. OBJECTIVE: Multiple modalities have been advocated for the treatment of sleeve gastrectomy leak, and there remains no consensus on the best treatment paradigm. For more than 10 years, we have variably attempted luminal occlusive therapies and repeated endoscopic debridement as treatment options. By evaluating the outcomes from these approaches, we aimed to determine whether the first management strategy is superior to the second in terms of outcomes. METHODS: Patients were analyzed by group (luminal occlusive therapy versus repeated endoscopic debridement). Leaks were then stratified by radiologic appearance on computed tomography, defined as phlegmon, collection, contrast medium leak, or fistula. The primary outcome was length of stay (LOS). Secondary outcomes were comprehensive complication index and the need for resection. RESULTS: There were 54 patients, with 22 in the luminal occlusion group and 32 in the repeated debridement group. There was no difference in LOS (59.8 ± 41.6 versus 46.5 ± 51.2 days, P = .179) and no difference in the requirement for resection (4 versus 3 resections, p = .425). Subset analysis suggested that patients who underwent operative versus conservative management (P = .006) had a longer LOS. Excluding management strategy, radiologic appearance on admission significantly predicted LOS (P = .0053). Patients presenting with fistula (84 ± 25.4 days) and contrast medium leak (64.1 ± 40 days) had a significantly longer LOS than those diagnosed with phlegmon (13.5 ± 5.5 days). Radiologic appearance was predictive of complication severity (P < .0001) and salvage resection (P = .008). CONCLUSION: There was no significant difference in outcomes between patients treated with intraluminal occlusion or repeated debridement. Initial radiologic appearance was predictive of LOS and complication severity. This highlights the need for routine use of a validated classification system in studies reporting outcomes and treatment of sleeve leaks.

Comparative Evaluation of Efficacy of Different Irrigating Needles and Devices in Removal of Debris from Apical Third of Root Canal: An In-vitro SEM Study.

BACKGROUND: Irrigants were required to eliminate the microbes and debris from the intraradicular space and must have direct contact with the entire root canal wall. Therefore, different irrigation methods have been proposed to deliver the irrigant as close as possible to the remote areas of the root canal. AIM: The aim of the present study is to evaluate the cleaning efficacy of single-beveled needle, side-vented needle, endovac, and endo-irrigator plus in the removal of debris from apical third of root canal by Scanning Electron Microscope. MATERIALS AND METHODS: Forty single-rooted freshly extracted human permanent mandibular premolars were collected. Root canals were cleaned and instrumented till X2 (25/06) with rotary Protaper Next at working length 1 mm short of the apex. Teeth were randomly divided into four equal groups: Group 1 (n = 10): Endovac, Group 2 (n = 10): Endo irrigator plus, Group 3 (n = 10): Side-vented needle, and Group 4 (n = 10): Single-beveled needle. Irrigation was done with 5.25% NaOCl, followed by 17% ethylenediaminetetraacetic acid. Samples were sectioned and examined under SEM at apical levels. STATISTICAL ANALYSIS: Analysis of variance followed by Tukey's post hoc test was performed. RESULTS: The level of debris removal efficacy is as follows: Endovac > Endo-irrigator plus > Side-vented needle ~ Single-beveled needle. CONCLUSION: Endovac showed the maximum number of debris removal and has better cleaning efficacy in the apical areas of the root canal, followed by Endo irrigator plus, Side-vented needle and Single-beveled needle.

Influence of volume of endodontic irrigants used in different irrigation techniques on root canal dentin microhardness.

INTRODUCTION: Overzealous application of endodontic irrigants affects the root canal dentin mechanical properties. The effect of volume of endodontic irrigants on the microhardness of root canal dentin has not been studied. AIM: This study assessed the effect of volume of endodontic irrigants used in different final irrigation activation techniques on root canal dentin microhardness (RCDM). METHODOLOGY: Sixty human maxillary central incisors were embedded in acrylic resin in Kuttler's endodontic cube to the level of cementoenamel junction. The root samples were randomly divided into 4 experimental groups (n = 15): Group-NI-needle irrigation, Group-PUI-continuous passive ultrasonic irrigation, Group-EndoVac-apical negative pressure system, Group combination- EndoVac + PUI irrigation. Root canals were instrumented up to size 40 (F4). The resin mounted specimens were sectioned longitudinally into two halves and were reassembled in Kuttler's kube to carry out final irrigation activation. A predetermined standardized volume of irrigants was used in each group. The RCDM was measured after root canal instrumentation and after final irrigation using Vicker microhardness tester (coronal, middle, and apical third). The reduction in RCDM values (p < 0.0086) were analyzed using Kruskal Wallis and Mann Whitney-U tests. RESULTS: Reduction in RCDM was observed with all the endodontic irrigating techniques tested. EndoVac and combination irrigation techniques showed maximum reduction in RCDM in all thirds of root canal. CONCLUSION: It is concluded that the volume of irrigants and agitation plays a role in reducing RCDM. The overall volume of irrigants to cause maximum reduction was 25 ml, beyond which neither volume nor agitation affects RCDM.

Micro-cleanliness of Hard Tissue Debris After Advanced Irrigation and Comparison Between EndoVac and XP-endo Finisher: A Microcomputed Tomographic Study.

INTRODUCTION: Conventional irrigation techniques do not remove debris adequately. The remaining tissue debris cause infection inside the root canal and may also affect the seal of the root canal. The study aimed to compare the ability of EndoVac (EV) with XP-endo finisher (XPF) in debris removal using micro-CT analysis. MATERIALS AND METHODS: We used 12 lower first permanent molar human teeth for this study. The root canals were instrumented using a small TF adaptive system. Then, the volume of debris was calculated. Teeth were divided into two groups, according to advanced irrigation methods, with six teeth per group: EV group and XPF group. The volume of debris was calculated again. The paired-sample t-test was used to compare the volume of the debris before and after the use of advanced irrigation methods with the statistical significance of P < 0.05. The percentage of debris reduction was also calculated. RESULTS: Both EV and XPF showed a significant decrease of debris in the mesial canals (P < 0.05), whereas EV only showed a significant reduction of debris in the distal canals. CONCLUSION: Both EV and XPF were able to significantly reduce debris after instrumentation in the mesial canals of lower first mandibular molars. CLINICAL SIGNIFICANCE: The study provides insight into the recent advanced methods used in debris removal and canal disinfection.

Efficiency of Different Endodontic Irrigation and Activation Systems, Self-Adjusting File Instrumentation/Irrigation System, and XP-Endo Finisher in Removal of the Intracanal Smear Layer: An Ex vivo Scanning Electron Microscope Study.

AIM: This ex vivo study was designed to evaluate and compare different endodontic irrigation and activation systems, the self-adjusting file (SAF) instrumentation/irrigation system, and XP-endo finisher for removal of intracanal smear layer. MATERIALS AND METHODS: Fifty recently extracted, noncarious human intact single-rooted premolars were selected and divided into five groups (n = 10) according to the root canal irrigation systems; syringe and needle irrigation, passive ultrasonic irrigation (PUI), EndoVac irrigation system, SAF system, and XP-endo finisher. All groups were prepared to apical size F4 file except for the SAF group which was prepared to apical size 20 K-file and then instrumented with the SAF file. Each sample was subjected to final irrigation using different irrigation/activation systems. After splitting the samples, one half of each root was selected for examination under scanning electron microscope. The irrigation systems were compared using the Fisher's exact test with significance set at P < 0.05. RESULTS: In the coronal part, there was no difference among the groups. In the mid-root section, the results of the PUI, EndoVac, SAF, and XP-endo finisher groups tended to be better than syringe and needle irrigation, but the difference was not significant. The apical part of the canal, the SAF system, and XP-endo finisher group seemed to be cleaner than those of the EndoVac group, but this difference was not significant. CONCLUSIONS: Within the limitations of the present study, SAF system and XP-endo finisher group cleaned the apical part of the canal more efficiently than EndoVac, PUI, and syringe and needle irrigation.

Success of endoscopic vacuum therapy for persistent anastomotic leak after esophagectomy - A case report.

INTRODUCTION: Endoscopic vacuum (endovac) therapy has shown excellent outcomes when used for esophageal anastomotic leaks. The results of endovac therapy are superior to those of other endoscopic therapies for esophageal leaks. CASE PRESENTATION: We present a case of a 70-year-old male with esophageal adenocarcinoma who underwent Ivor Lewis esophagogastrectomy that was complicated by an esophageal leak. After failure of multiple endoscopic therapies (i.e. stents and clips), he responded well to endovac therapy. DISCUSSION: Endovac therapy is extremely useful for the treatment of esophageal leaks. The widespread use of endovac therapy is feasible, even in smaller community hospitals. CONCLUSION: Endovac therapy is a valuable tool that can be used widely for the management of esophageal leaks. Commercially available devices need to be developed in order to facilitate endovac placement and exchange so that the procedure is less dependent on the skill of the operator.

Gastro-colo-diaphragmatic fistula after sleeve gastrectomy.

INTRODUCTION: Postsleeve gastrectomy fistula is a serious complication, and its management remains quite challenging. The clinical presentation of chronic fistula after sleeve gastrectomy (SG) varies widely and depends on the type of fistula. Management requires a multidisciplinary approach and patient cooperation. CASE PRESENTATION: We present a case of a 41-year-old woman with a body mass index (BMI) of 46 kg/m2 who initially underwent laparoscopic sleeve gastrectomy in our hospital. Later, she developed a gastro-colo-diaphragmatic fistula (GCD), which was successfully treated using an endolaparoscopic approach. Follow-up imaging and endoscopy showed complete healing of the fistula, as well as a marked clinical improvement of the patient. DISCUSSION: Gastro-colo-diaphragmatic fistula following sleeve gastrectomy is an extremely rare complication. This is the first case of a GCD fistula after sleeve gastrectomy that has been reported in the literature. CONCLUSION: One staged endolaparoscopic management was successful approach in our case and can be considered for complex gastric fistula following sleeve gastrectomy.