Esophagus to Small Intestine
Am J Gastroenterol. 2023;118(10):1797–806
Endoscopic vacuum therapy for upper gastrointestinal leaks and perforations: Analysis from a multicenter Spanish registry
Introduction: Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. The authors aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality.
Methods: This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022.
Results: 102 patients were included: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01–1.05, p = 0.005). EVT failure (OR = 24.5, 95% CI: 4.5–133, p = 0.001) and development of pneumonia after EVT (OR = 246.97, 95% CI: 11.15–5472.58, p = 0.0001) were independent predictors of in-hospital mortality.
Discussion: Endoscopic vacuum therapy (EVT) is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.