VACStent For The Treatment Of Upper Gastrointestinal Tract Leaks And Defects: Results From Prospective Series In A Tertiary Referral Center

Aims The VACStent is a fully covered stent encased in a polyurethane sponge cylinder, offering a promising approach for treating upper gastrointestinal (UGI) tract leaks and defects; however, available evidence remains limited and preliminary.

Methods This prospective study enrolled all consecutive patients with an UGI leak/defect treated with VACStent placement from May 2023 to September 2024. The primary outcome was clinical success (CS). Secondary outcomes included technical success (TS) and adverse events (AEs). CS was defined as defect healing confirmed by endoscopic and radiologic evaluation, while TS was defined as successful stent placement and removal.

Results Fourteen patients [64.3% male, median age 65 years (IQR 59-75)] with an UGI leak or defect (78.6% with anastomotic leak post-Ivor-Lewis esophagectomy) were enrolled. VACStent was the first-line treatment in 92.9% of cases, with a median leak size of 6 mm (IQR 5-11), and 28.6% of patients had previously undergone re-surgery. The median time from surgery/endoscopy to initial VACStent placement was 7 days (IQR 3-9). The median treatment duration was 9.5 days (IQR 7-14), with a median hospital stay of 29.5 days (IQR 21-63) and a median of 2 VACStents per patient (IQR 1-2). CS rate was 64.3% (9/14 patients); among the 5 remaining cases, 4 required rescue surgery, and one patient died of sepsis. TS was 96.7% (30/31 procedures); one case of technical failure occurred in a patient with an anastomotic leak who had previously received radiotherapy for mediastinal lymphoma. No VACStent-related AEs were observed.

Conclusions In our prospective series, VACStent has proven to be an effective and safe treatment option for upper GI leaks. Larger controlled studies are warranted to better define its role and optimize outcomes in this complex setting.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025