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

Abstract

Background and study aims Esophageal defects (leaks, fistulas, and perforations) are associated with significant morbidity and mortality. Endoluminal vacuum-assisted closure (EVAC) is a novel intervention that entails the use of sponges in the defect along with negative pressure to achieve granulation tissue formation and healing and has been gaining popularity. We performed a systematic review and pooled analysis of available literature to assess the safety and effectiveness of EVAC for esophageal defects. Patients and methods We queried PubMed/Medline, Embase, Cochrane, and Web of Science through September 25, 2020 to include all pertinent articles highlighting the safety and effectiveness profile of EVAC for esophageal defects. Pooled rates, 95 % confidence intervals (CIs), and heterogeneity (I2 ) were assessed for each outcome. Results A total of 18 studies with 423 patients were included (mean age 64.3 years and males 74.4 %). The technical success for EVAC was 97.1 % (CI: 95.4 %–98.7 %, I2 = 0 %). The clinical success was 89.4 % (CI: 85.6 %–93.1 %, I2 = 36.8 %). The overall all-cause mortality and adverse events (AEs) noted were 7.1 % (CI: 4.7 %–9.5 %, I2 = 0 %) and 13.6 % (CI: 8.0 %–19.1 %, I2 = 68.9 %), respectively. The pooled need for adjuvant therapy was 15.7 % (CI: 9.8 %–21.6 %, I2 = 71.1 %). Conclusions This systematic review and meta-analysis showed high rates of technical success, clinical success, and low all-cause mortality and AEs using EVAC. Although the technique is a promising alternative, the lack of comparative studies poses a challenge in making definite conclusions regarding use of EVAC compared to other endoscopic modalities, such as clips and stents.

The VACStent trial: combined treatment of esophageal leaks by covered stent and endoscopic vacuum therapy

“…Definitive morphologic healing was observed in 80% of patients after an average of 15 days of VACStent placement. This corresponds to a healing rate as can be expected with EVT through a PU sponge [6,13]. However, the healing rate is affected by the chronicity of an existing leak or fistula, the site of the defect, and the applied suction vacuum [13].…”

Preemptive endoluminal vacuum therapy with the VACStent—A pilot study to reduce anastomotic leakage after Ivor Lewis hybrid esophagectomy

“…The treatment with the VACStent should be carefully counterbalanced against its potential risks. Esophageal stenosis with clinical dysphagia might be possibly triggered by EVT ( 17 ). Late complications of pEVT like anastomotic strictures may have been missed in this pilot study and should be evaluated in future prospective clinical trials.…”

Vacuum-stent: A combination of endoscopic vacuum therapy and an intraluminal stent for treatment of esophageal transmural defects

“…The effect is based on negative pressure wound therapy, resulting in improved wound healing, exudate control and stimulation of perfusion (10). In current literature, success rates are 70 to 100%, with mortality rates of 7 to 18% and complication rates of 10 to 14%, mainly sponge dislocation and stenosis (8,11).…”