Año 2025 / Volumen 117 / Número 6
Carta
Endoscopic vacuum therapy: management of upper gastrointestinal anastomotic leaks and esophageal perforations

352-353

DOI: 10.17235/reed.2024.10424/2024

María de Armas Conde, Carmen Díaz-López, Vanessa Concepción-Martín, María del Pilar Borque-Barrera,

Resumen
Background and study aims: Upper gastrointestinal tract (UGT) leaks are associated with severe morbidity and mortality. Endoluminal vacuum (EVAC) therapy is a promising approach for repairing effectively these defects. Our study describes the results obtained from a series of cases treated with EVAC for the management of esophageal anastomotic (EA) leak following esophagectomy for cancer, gastroenteric (GE) anastomoses leak after bariatric surgery and esophageal perforation (EP). Patients and methods: We retrospectively analyzed ten patients who had an EA and GE anastomoses leaks and EP treated with EVAC. We described the results of the sample in terms of treatment failure, treatment duration, and number of EVAC replacements. Results: Five patients underwent esophagectomy with neoadjuvant radio-chemotherapy, one patient underwent gastrojejunal bypass bariatric surgery and there were four EP. The median size of mucosal defects was 6,9 mm. The median duration of treatment was thirteen days with 3,6 interventions performed, every three to four days. Treatment success rate was 70 %. Treatment failure was 30 %: two patients required surgery and in one case an endoluminal prosthesis. Conclusions: EVAC therapy is an appropriate treatment for the management of postoperative fistulas in the UGT. Longer treatments are associated with neoadjuvant chemoradiotherapy and larger fistulas.
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Bibliografía
Lange J, Kähler G, Bernhardt J, et al. The VACStent trial: combined treatment of esophageal leaks by covered stent and endoscopic vacuum therapy. Surg Endosc. 2023 May;37(5):3657-3668.
Kouladouros K. Applications of endoscopic vacuum therapy in the upper gastrointestinal tract. World J Gastrointest Endosc. 2023 Jun 16;15(6):420-433.
Zhong WD, Hu G, Feng ZH, et al. Endoluminal Vacuum-Assisted Closure Therapy for Upper Gastrointestinal Leak, Perforation, and Fistula: A Case Series and Literature Review. Dig Dis. 2023;41(3):506-512.
Panneerselvam K, Jacob JS, Samuel RE, et al. Endoscopic vacuum therapy for treatment of spontaneous and iatrogenic upper gastrointestinal defects: a case series. Clin Endosc. 2023 May 9.
Gutschow CA, Schlag C, Vetter D. Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it. Langenbecks Arch Surg. 2022 May;407(3):957-964.
Instrucciones para citar
de Armas Conde M, Díaz-López C, Concepción-Martín V, Borque-Barrera M. Endoscopic vacuum therapy: management of upper gastrointestinal anastomotic leaks and esophageal perforations. 10424/2024


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Ficha Técnica

Recibido: 24/03/2024

Aceptado: 02/04/2024

Prepublicado: 18/04/2024

Publicado: 10/06/2025

Tiempo de prepublicación: 25 días

Tiempo de edición del artículo: 443 días


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