Endoluminal Vacuum Assisted Closure (E-Vac) Therapy for Postoperative Esophageal Fistula: Successful Case Series and Literature Review

Abstract

Background: Treatment of esophageal perforations and postoperative anastomotic leaks of the upper gastrointestinal tract remains a challenge. Endoluminal vacuuma assisted closure (E-vac) therapy has positively contributed, in recent years, to the management of upper gastrointestinal tract perforations by using the same principle of vacuum assisted closure therapy of external wounds. The aim is to provide continuous wound drainage and to promote tissue granulation, decreasing the needed time to heal with a high rate of leakage closure.Report of cases: A series of two different cases with clinical and radiological diagnosis of esophageal fistulas, recorded during the 2018 to 2019 period at our institution, is presented. The first one is a case of anastomotic leak after esophagectomy for cancer complicated by pleuro-mediastinal abscess; while the second one is a leak of an esophageal suture, few days after resection of a bronchogenic cyst perforated into the esophageal lumen. Both cases were successfully treated with E-vac therapy.Conclusion: Our results confirm the usefulness of E-vac therapy in the management of anastomotic and non-anastomotic esophageal fistulas. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy.

Endoscopic Vacuum-assisted Closure in a Patient with an Overtube-induced Esophageal Perforation

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