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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(05): E686-E693
DOI: 10.1055/a-1781-0827
Original article

Endoscopic vacuum therapy (EVT) for acute esophageal perforation: Could it replace surgery?

Petros Stathopoulos
1   Division of Interdisciplinary Endoscopy, Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
,
Malte Zumblick
1   Division of Interdisciplinary Endoscopy, Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
,
Sabine Wächter
2   Department of Visceral, Thoracic and Vascular Surgery, University Hospital Marburg, Marburg, Germany
,
Leif Schiffmann
3   Department of General, Visceral and Thoracic Surgery, Helios Hospital Aue, Aue, Germany
,
Thomas M. Gress
4   Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
,
Detlef Bartsch
2   Department of Visceral, Thoracic and Vascular Surgery, University Hospital Marburg, Marburg, Germany
,
Guido Seitz
5   Department of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
,
Ulrike W. Denzer
1   Division of Interdisciplinary Endoscopy, Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
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Abstract

Background and study aims Acute esophageal perforation is a potentially life-threating condition that demands a multidisciplinary approach. Based on recently published data indicating that EVT may be effective in managing esophageal perforation, we report our institution’s experience with EVT in this clinical setting.

Patients and methods We retrospectively analyzed all 10 patients with acute esophageal perforation from May 2018 to January 2021, using descriptive statistics. The primary outcome was successful closure of the perforation. Secondary outcomes included the length of treatment, number of endoscopic procedures required, and complication rate.

Results All patients (site of perforation: 4 upper, 2 middle, 4 lower esophagus; etiology: 8 iatrogenic, 2 foreign body ingestion) were treated with EVT successfully. In eight cases, EVT was started immediately after the perforation, in the other two cases 1 and 2 days later. The median (interquartile range) number of endoscopic procedures was 2.5 (range, 2–3) and the median duration of treatment was 7.5 days (range, 7–11.5). The sponge was placed in eight cases intraluminally, in the other two cases initially intracavitary. No complication occurred.

Conclusions EVT is highly effective for managing acute esophageal perforation within 1 to 3 weeks. Immediate start of EVT to prevent abscess formation and induce defect closure is crucial.



Publication History

Received: 31 October 2021

Accepted after revision: 24 January 2022

Accepted Manuscript online:
24 February 2022

Article published online:
13 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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