Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta‐analysis

Abstract

Background Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. Objectives The aim of this study is to perform a systematic review and meta‐analysis to investigate the efficacy and safety of self‐expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. Methods Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. Results Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10–0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03–0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38–20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13–0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. Conclusion Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.

Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: Systematic review and meta-analysis

“…In recent meta-analyses, EVAC was compared to SEMS and a lower overall AE rate (risk difference: 0.24, 95 % CI 0.13–0.35) and mortality (OR: 0.39, 95 % CI 0.18–0.83) was noted for EVAC 25 26 . The reason for fewer AEs with EVAC may stem from the difference in technique.…”

Postoperative Leckagen im Gastrointestinaltrakt – Diagnostik und Therapie

“…Mittlerweile liegen erste Metaanalysen [ 24 ] vor, die SCS und EUT miteinander vergleichen. Diese fassen die Ergebnisse von mehreren retrospektiven Studien zusammen [ 25 ]. Bei den meisten Patienten besteht eine AI nach Ösophagektomie.…”

Endoskopische Vakuumtherapie der Anastomoseninsuffizienz – Schritt für Schritt

“…Jüngere Studien konnten einen Vorteil der EVT gegenüber SEMS für die Versorgung von Anastomoseninsuffizienzen im oberen GIT zeigen [22,23]. Hierbei wies die EVT eine signifikante Steigerung der Heilungsrate bei kürzerer Behandlungsdauer auf.…”

“…Hierbei wies die EVT eine signifikante Steigerung der Heilungsrate bei kürzerer Behandlungsdauer auf. Während die Metaanalyse von Scognamiglio et al [22] keine Unterschiede in der Komplikationsrate fand, konnten do Monte et al [23] eine signifikante Reduktion von Komplikationen gegenüber dem Stentverfahren nachweisen. Einen signifikanten Unterschied in der Krankenhausverweildauer konnte keine der Metaanalysen feststellen.…”