ENDOSCOPIC VACUUM THERAPY for ESOPHAGEAL PERFORATION: A MULTICENTER RETROSPECTIVE COHORT STUDY

Abstract

Background and study aim: Endoscopic vacuum therapy (EVT) is a novel treatment for esophageal perforations. The aim of this study was to describe initial experiences with EVT of esophageal perforations due to iatrogenic cause, Boerhaave syndrome or other perforations not related to prior upper gastrointestinal surgery. Patients and 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 endpoint was successful defect closure by EVT, with or without the use of other endoscopic treatment modalities, and secondary endpoints included mortality and adverse events. Results: 27 patients were included (median age 71). The success rate was 89% (24/27, 95% CI [77-100]). In 3 patients EVT failed: 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 (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 rate.