Safety and efficacy of endoscopic vacuum therapy for the treatment of perforations and anastomotic leaks of the upper gastrointestinal tract

Introduction: Self-expanding metal stents (SEMS) are an established option for treating leaks in the upper gastrointestinal tract, and endoscopic vacuum therapy (EVT) has become a promising alternative. A novel approach is the use of an esophageal hybrid SEMS (VACStent®), which can maintain esophageal passage during EVT. We present the first study demonstrating successful use of the VACStent® for treating leaks of the upper gastrointestinal tract. Method: We performed a retrospective, single-center study of all patients who underwent endoscopic stenting with the VACStent® of leaks in the upper gastrointestinal tract. Results: Indications for treatment with the VACStent® were: iatrogenic esophageal perforation (n = 1), spontaneous perforation (n = 2), esophageal fistula (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 5). Successful application of the VACStent® was achieved in all patients (n = 10; 100%) with a total of 15 interventions. VACStent® therapy was used as a first-line treatment in 5 patient (success rate 80%; 4 out 5 patients) and as a second-line treatment after failed previous endoscopic therapy in 5 patients (success rate 60%; 3 out of 5 patients). Overall, VACStent® treatment was successful in 70% of the patients (7 out of 10). No severe VACStent® treatment-related adverse events occurred. Conclusion: The initial experience has been that the technical application of the VACStent® is safe and technically feasible. However, due to the small number of patients this study could not show the clear advantages of this novel hybrid stent. More studies are necessary to show significant advantages.

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Endoscopic vacuum therapy in the treatment of anastomotic leak in the upper gastrointestinal tract. First experience and review of literature

Endoskopicheskaya khirurgiya ◽

10.17116/endoskop20162223-9 ◽

2016 ◽

Vol 22 (2) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

I. E. Khatkov ◽

K. V. Shishin ◽

I. Yu. Nedoluzhko ◽

N. A. Kurushkina ◽

R. E. Izrailov ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Anastomotic Leak ◽

Upper Gastrointestinal Tract ◽

Vacuum Therapy ◽

Review Of Literature ◽

Endoscopic Vacuum Therapy ◽

Upper Gastrointestinal

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A new hybrid stent using endoscopic vacuum therapy in treating esophageal leaks: a prospective single-center experience of its safety and feasibility with mid-term follow-up

Diseases of the Esophagus ◽

10.1093/dote/doab067 ◽

2021 ◽

Author(s):

Seung-Hun Chon ◽

Julia Scherdel ◽

Isabel Rieck ◽

Florian Lorenz ◽

Thomas Dratsch ◽

...

Keyword(s):

Gastrointestinal Tract ◽

High Energy ◽

Oral Feeding ◽

Upper Gastrointestinal Tract ◽

Metal Stents ◽

Vacuum Therapy ◽

Single Center ◽

Current Form ◽

Endoscopic Vacuum Therapy ◽

Upper Gastrointestinal

Summary Self-expandable metal stents (SEMS) and endoscopic vacuum therapy (EVT) are endoscopic options for treating leaks of the esophagus. VACStent® is a variant of SEMS that aims to combine the advantages of SEMS and EVT in one device. Due to this unique construction, VACStent® can build a barrier to the leak and facilitate wound healing with EVT, all while maintaining intestinal passage. We present the first prospective feasibility study of VACStent® for treating leaks of the upper gastrointestinal tract. Between September 2019 and November 2020, we performed a prospective, investigator-initiated, single-center study and included all patients who underwent endoscopic stenting with VACStent® for various kinds of esophageal leaks, such as spontaneous, iatrogenic or anastomotic leaks. We included 20 patients, who underwent a total of 24 endoscopic VACStent® implantations. Technical success of the application of the VACStent® was achieved in all interventions (n = 24, 100%). Overall, clinical success in closing the leaks with VACStent® treatment was achieved in 60% of patients (12/20). No severe VACStent® treatment-related adverse events occurred. Oral feeding with supplement high-energy drinks failed in all patients due to clogging of the suction tube. VACStent® is a safe and feasible endoscopic treatment option for leaks of the upper gastrointestinal tract. However, our data could not show the expected advantage of orally feeding the patients during the treatment with the VACStent® in its current form. Efficacy of VACStent® compared to EVT or SEMS needs to be investigated in a further study. ClinicalTrials.gov Identifier: NCT03962179.

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