Abstract
A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) has shown rather excellent efficacy in managing UGI defects. We conducted a systematic review and meta-analysis to synthesise the available evidence on the efficacy of EVT in patients with transmural defects of the UGI tract. We searched the PubMed, Cochrane Library, and Embase databases for publications on the effect of EVT on successful closure, mortality, complications, and post-EVT stricture. Methodological quality was assessed using the Newcastle-Ottawa quality assessment scale. This meta-analysis included 29 studies involving 498 participants. The pooled estimate rate of EVT for successful closure was 0.85 (95% confidence interval [CI]: 0.81–0.88). The pooled estimate rate for mortality, complications, and post-EVT stricture was 0.11, 0.10, and 0.14, respectively. According to the aetiology of the transmural defect (perforation vs. leak and fistula), no significant difference was found in successful closure (odds ratio [OR]: 1.45, 95% CI: 0.45–4.67), mortality (OR: 0.77, 95% CI: 0.24–2.46), complications (OR: 0.94, 95% CI: 0.17–5.15), and post-EVT stricture (OR: 0.70, 95% CI: 0.12–4.24). The successful closure rate was significantly higher with EVT than with self-expanding metal stent (SEMS) placement (OR: 3.52, 95% CI: 1.79–6.91). In conclusion, EVT is an effective and safe treatment for treating leaks and fistulae as well as perforations in UGI defects. Moreover, EVT seems to be a better treatment option than SEMS placement in healing UGI defects.
Novel treatment options for perforations of the upper gastrointestinal tract: Endoscopic vacuum therapy and over-the-scope clips