Clin Endosc.  2023 Nov;56(6):754-760. 10.5946/ce.2022.177.

Endoscopic vacuum therapy for treatment of spontaneous and iatrogenic upper gastrointestinal defects

• Panneerselvam K
• Jacob JS
• Samuel RE
• Tau A
• Ketwaroo GA
• Abidi WM
• Sealock RJ

• KMID: 2547897
• DOI: http://doi.org/10.5946/ce.2022.177

Abstract

Background/Aims
Endoscopic vacuum therapy (EVT) can heal a variety of defects within the gastrointestinal (GI) tract via applying negative pressure, which reduces the defect size, aspirates the infected fluid, and promotes granulation tissue. Here we present our experience with EVT as it relates to both spontaneous and iatrogenic upper GI tract perforations, leaks, and fistulas.
Methods
This retrospective study was conducted at four large hospital centers. All patients who underwent EVT between June 2018 and March 2021 were included. Data on multiple variables were collected, including demographics, defect size and location, number and intervals of EVT exchanges, technical success, and hospital length of stay. Student t-test and the chi-squared test were used to analyze the data.
Results
Twenty patients underwent EVT. The most common defect cause was spontaneous esophageal perforation (50%). The most common defect location was the distal esophagus (55%). The success rate was 80%. Seven patients were treated with EVT as the primary closure method. The mean number of exchanges was five with a mean interval of 4.3 days between exchanges. The mean length of hospital stay was 55.8 days.
Conclusions
EVT is a safe and effective initial management option for esophageal leaks and perforations.

Keyword

Esophagus; Fistula; Vacuum

Figure

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  Fig. 1. Constructed endoscopic vacuum therapy apparatus.

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  Fig. 2. Illustration of endoscopic vacuum therapy (EVT) case series. Relative width of base of each bar represents defect size. Cases with complete closure achieved are represented by triangles, and those without complete closure with rectangles. Dotted lines represent mean time of exchange.

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