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

Abstract

Background Acute esophageal perforation is a potentially life-threating condition, demanding a multi-disciplinary approach. Based on recently published data that EVT may be effective in managing esophageal perforation, we report our institution’s experience with EVT in this clinical setting. Methods We retrospectively analyzed all 10 patients with acute esophageal perforation from May 2018 to January 2021, using descriptive statistics. The primary outcome was the successful closure of the perforation. Secondary outcomes included the length of treatment, the number of endoscopic procedures required and the 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 8 cases EVT was started immediately after the perforation, in the other two cases one and two days later. The median (interquartile range) number of endoscopic procedures was 2,5 (2-3) and the median duration of treatment was 7,5 (7-11,5) days. The sponge was placed in 8 cases intraluminal, in the other 2 cases initially intracavitary. No complication occurred. Conclusion EVT is highly effective for managing acute esophageal perforation within 1-3 weeks. Immediate start of EVT to prevent abscess formation and induce defect closure is crucial.

Pulling instead of pushing: A case report of gastrostomy‐assisted pull technique as an alternative method for endoluminal sponge placement in EVAC therapy

“…This creates negative pressure therapy at the perforation site, causing a collapse of surrounding tissue forming the seal, which stimulates granulation of the wound to promote closure 7 . Beyond wound closure, EVT allows continuous drainage to reduce local edema and promote perfusion while reducing the chance of infection, all of which further its success 8 …”

“…Therefore, the choice to pull the sponge through the gastrostomy site is dependent on anatomy, provider comfort, center support, and multidisciplinary expertise. Additionally, patients treated successfully with this technique have reduced morbidity by avoiding repeat thoracotomy 8 …”

“…7 Beyond wound closure, EVT allows continuous drainage to reduce local edema and promote perfusion while reducing the chance of infection, all of which further its success. 8 EVAC is a minimally invasive procedure that can be used to treat perforation through placement of a sponge-like material to the affected region and connecting it to a vacuum pump. In this case, gastric access was obtained through PEG to allow sponge placement via the pull-through technique.…”

“… 7 Beyond wound closure, EVT allows continuous drainage to reduce local edema and promote perfusion while reducing the chance of infection, all of which further its success. 8 …”

Treatment of an esophageal perforation in a high-risk elderly patient: A novel use of a through-the-scope suturing system

“…There was no apperent infection in the neck or mediastinum and no further intervention was needed for source control. Unfortunately the patient deceased on POD 28 due to ventilator pneumonia 1 2 3 4 5 6 7 8 9 .…”