Primary and Rescue Endoluminal Vacuum Therapy in the Management of Esophageal Perforations and Leaks

Abstract

Background: To investigate the efficacy of primary and rescue endoluminal vacuum (EVAC) therapy in the treatment of esophageal perforations and leaks.Methods: We conducted a retrospective review of a prospectively gathered, Institutional Review Board (IRB) approved database of EVAC therapy patients at our center from July 2013 to September 2016.Results: In all, 13 patients were treated for esophageal perforations or leaks. Etiologies included iatrogenic injury (n = 8), anastomotic leak (n = 2), Boerhaave syndrome (n = 1), and bronchoesophageal fistula (n = 2). In total, 10 patients underwent primary treatment and three were treated with rescue therapy. Mean Perforation Severity Scores (PSSs) in the primary and rescue treatment groups were 7 and 10, respectively. Average defect size was 2.4 (range: 0.5–6) cm. The rescue group had a shorter mean time to defect closure (25 vs. 33 days). In all, 12 of 13 defects healed. One death occurred following the implementation of comfort care. One therapy-specific complication occurred. Hospital length of stay (LOS) was longer in the rescue group (72 vs. 53 days); however, the intensive care unit (ICU) duration was similar between groups. Totally, 10 patients (83%) resumed an oral diet after successful defect closure.Conclusion: Utilized as either a primary or rescue therapy, EVAC therapy appears to be beneficial in the management of esophageal perforations or leaks.

Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period

“…Especially in the background of failure of the surgical repair or small defects, endoluminal vacuum therapy seems to be beneficial. Of note, time of hospitalization after endoscopic treatment has been reported between 21 and 54 days due to numerous interventions [13,26,27]. In our study, the median length of hospital stay was 20.5 days, which is shorter as compared to Schweigert et al [8], reporting a median length of stay of 31 days.…”

“…Thus, the PSS might be a useful tool to objectively identify patients, in whom a primary endoscopic approach should be further taken into account. In addition, recent reports have added endoluminal vacuum sponges as another potential tool in treating esophageal perforations with promising results [13,26,27]. Especially in the background of failure of the surgical repair or small defects, endoluminal vacuum therapy seems to be beneficial.…”

“…Small contained perforations can be managed conservatively with broad-spectrum antibiotics [8,12]. In addition, treatment with esophageal stents or sponges also seems to be feasible [4,6,7,13]. Extensive esophageal ruptures should be treated surgically, though.…”

Esophageal emergencies: WSES guidelines

“…[71]. Successful closure of esophageal defects by primary or rescue endoluminal vacuum therapy has been recently reported and may represent a promising alternative treatment for EP [87, 88].…”

Endoluminal Vacuum Assisted Closure (E-Vac) Therapy for Postoperative Esophageal Fistula: Successful Case Series and Literature Review

“…The permanent suction reduces wound secretion and oedema, improves microcirculation, induces granulation of the wound and decreases wound size by retraction. Since the 1990s, the number of indications for VAC Therapy has been steadily increasing [8][9] , more recently including its endoscopic application to perforations and stulae of the digestive tract, mainly in the rectum and esophagus. This paper reports the successful closure of two different kinds of oesophageal stula; the rst one is a complex anastomotic leak, complicated by pleuro-mediastinal abscess, after esophagectomy for cancer, which is the most common indication for this treatment.…”