Endoscopic vacuum therapy for esophageal perforation: a multicenter retrospective cohort study

Abstract

Background Endoscopic vacuum therapy (EVT) is a novel treatment for esophageal perforations. This study aimed to describe initial experience with EVT of esophageal perforations due to iatrogenic cause, Boerhaave syndrome, or other perforations not related to prior upper gastrointestinal surgery.

Methods Data from patients treated with EVT for esophageal perforation at five hospitals in three European countries, between January 2018 and October 2021, were retrospectively collected. The primary end point was successful defect closure by EVT, with or without the use of other endoscopic treatment modalities. Secondary end points included mortality and adverse events.

Results 27 patients were included (median age 71 years). The success rate was 89 % (24/27, 95 %CI 77–100). EVT failed in three patients: two deceased during EVT (septic embolic stroke, pulmonary embolism) and one underwent esophagectomy due to a persisting defect. Two adverse events occurred: one iatrogenic defect expansion during sponge exchange and one hemorrhage during sponge removal. Median treatment duration was 12 days (interquartile range [IQR] 6–16) with 1 sponge exchange (IQR 1–3).

Conclusion EVT is a promising organ-preserving treatment for esophageal perforations, with a success rate of 89 %. More experience with the technique and indications will likely improve success rates.

^‡ Co-first authors.

Publikationsverlauf

Eingereicht: 28. September 2022

Angenommen nach Revision: 24. Februar 2023

Accepted Manuscript online:
24. Februar 2023

Artikel online veröffentlicht:
20. April 2023

• References

• 1 Biancari F, D’Andrea V, Paone R. et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 2013; 37: 1051-1059
• 2 Rohatgi A, Papanikitas J, Sutcliffe R. et al. The role of oesophageal diversion and exclusion in the management of oesophageal perforations. Int J Surg 2009; 7: 142-144
• 3 Tavares G, Tustumi F, Tristão LS. et al. Endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy: a systematic review and meta-analysis. Dis Esophagus 2021; 34: doaa132
• 4 Jung DH, Huh CW, Min YW. et al. Endoscopic vacuum therapy for the management of upper GI leaks and perforations: a multicenter retrospective study of factors associated with treatment failure (with video). Gastrointest Endosc 2022; 95: 281-290
• 5 Scognamiglio P, Reeh M, Karstens K. et al. Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis. Endoscopy 2020; 52: 632-642
• 6 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 7 Abbas G, Schuchert MJ, Pettiford BL. et al. Contemporaneous management of esophageal perforation. Surgery 2009; 146: 749-755
• 8 Chan SM, Auyeung KKY, Lam SF. et al. Current status in endoscopic management of upper gastrointestinal perforations, leaks and fistulas. Dig Endosc 2022; 34: 43-62
• 9 Aziz M, Haghbin H, Sharma S. et al. Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: systematic review and meta-analysis. Endosc Int Open 2021; 9: E1371-E1380
• 10 Lange J, Dormann A, Bulian DR. et al. VACStent: combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage. Endosc Int Open 2021; 9: E971-E976
• 11 Chon SH, Scherdel J, Rieck I. et al. A new hybrid stent using endoscopic vacuum therapy in treating esophageal leaks: a prospective single-center experience of its safety and feasibility with mid-term follow-up. Dis Esophagus 2021; 35: 1-8
• 12 Harikrishnan S, Servarayan Murugesan C, Karthikeyan R. et al. Challenges faced in the management of complicated Boerhaave syndrome: a tertiary care center experience. Pan Afr Med J 2020; 36: 65
• 13 Paspatis GA, Arvanitakis M, Dumonceau JM. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020. Endoscopy 2020; 52: 792-810