EVT-Registry

Introduction: Endoscopic vacuum therapy (EVT) has gained a greater role in management of transmural defects in the upper gastrointestinal (GI) tract, including anastomotic leakage and esophageal perforation (e.g. Boerhaave syndrome and iatrogenic causes). The vacuum-stent is a new treatment modality, combining the benefits of EVT and an intraluminal stent.

Patients and methods: This prospective case series describes the first ten cases of a transmural defect in the upper GI tract treated with a vacuum-stent in a tertiary referral center. All patients signed informed consent for prospective registration of relevant data on treatment and outcomes in a specially designed database. Outcome parameters were successful closure of the defect, number of endoscopies, duration of treatment and adverse events.

Results: In total, ten patients treated with a vacuum-stent were included. Eight patients had anastomotic leakage after esophageal resection, of whom six were treated with vacuum-sponge and vacuum-stent, and two with vacuum-stent only. One patient had Boerhaave syndrome, treated with vacuum-sponge and vacuum-stent, and one had an iatrogenic perforation during pneumodilation for achalasia, treated with vacuum-stent only. Success rate was 100%, requiring a median of 5 (IQR 3–12) EVT-related endoscopies with a treatment course of median 18 (IQR 12–59) days. One patient developed an esophageal stricture, but no other vacuum-stent related adverse events were observed.

Conclusion: The vacuum-stent, which combines benefits of EVT and an intraluminal stent, shows great feasibility and efficacy in treatment of transmural defects in the upper GI tract. Future studies should point out whether this device can prevent major (re-)surgery in these patients.

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.

Background and study aim: Recently, endoscopic vacuum therapy (EVT) was introduced as treatment for anastomotic leakage (AL) after upper gastrointestinal (GI) surgery. Aim of this study was to describe the initial experiences with EVT for AL after upper GI surgery in a tertiary referral center.

Patients and methods: Patients treated with EVT for AL after upper GI surgery were included retrospectively (January 2018-June 2021) and prospectively (June 2021-October 2021). The primary endpoint was EVT success rate. Secondary endpoints included mortality and adverse events.

Results: 38 patients were included (31 men, mean age 66 years). 27 patients had undergone an esophagectomy with gastric conduit reconstruction and 11 a total gastrectomy with esophago-jejunal anastomosis. EVT was successful in 28 patients (74%, 95% CI [57-87]). In 10 patients EVT failed: 1 deceased due to radiation pneumonitis, 2 had EVT-associated complications and in 7 defect closure was not achieved. Mean duration of successful EVT was 33 days, with median 6 EVT-related endoscopies. Median hospital stay was 45 days.

Conclusion: This initial experience with EVT for anastomotic leakage after upper GI surgery demonstrated a success rate of 74%. EVT is a promising therapy that could prevent major re-surgery. More experience with the technique and its indications will likely improve success rates in the future.

This video describes a case of successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using EsoSponge and VACStent.