Endoscopic vacuum therapy (EVT) in the management of oesophageal perforations and post-operative leaks

Current Status of Endoscopic Vacuum Therapy in the Management of Esophageal Perforations and Post-Operative Leaks

“…In our early experience at our tertiary center in Oxford, we published the largest case series of EVT in the UK and demonstrated an 86% success rate of defect closure with a median duration of treatment of 13 days. 30 Since this time, our experience has continued to grow, and we continue to observe similar rates of success. These results are consistent with previously reported EVT success rates, including the retrospective analysis of Brangewitz and colleagues, in which 34 patients demonstrated an 84% closure rate of intrathoracic esophageal leaks, 32 and Bludau et al, 17 who successfully closed 86% of esophageal perforations in a group of 14 patients using this technique.…”

“…Since the first reported use of EVT in the upper gastrointestinal tract in 2008, specifically in the context of intrathoracic anastomotic leak, the range and scope of utility of the approach has widened substantially to include perforations, anastomotic leaks, and fistulae in a variety of clinical settings [ 5 ]. This has been demonstrated in multiple case reports across countries and institutions ( Table 1 ) [ 1 , 5 , 12 - 30 ], with Germany being a particular focus of expertise and progress in the field. The approach has been increasingly demonstrated to be efficacious across a spectrum of etiologies, ages, comorbidities, and patient conditions.…”

“…This effect is highlighted by studies in which monitoring of inflammatory markers and patient condition have shown a significant reduction in white cell count and C-reactive protein following initiation of EVT treatment. 12,20,25,30 This rapid source control helps to stabilize patients who are critically ill at the onset of EVT treatment, thus reducing the need for intensive care support, which is a major advantage of the approach. 27 The timing of EVT initiation must also be considered, and prompt treatment is widely acknowledged as a major factor influencing its therapeutic outcome.…”

“…In our early experience at our tertiary center in Oxford, we published the largest case series of EVT in the UK and demonstrated an 86% success rate of defect closure with a median duration of treatment of 13 days [ 30 ]. Since this time, our experience has continued to grow, and we continue to observe similar rates of success.…”

“…EVT is effective not only in facilitating closure of esophageal wall defects but also in rapidly controlling sepsis by efficiently draining the associated infected wound cavities. This effect is highlighted by studies in which monitoring of inflammatory markers and patient condition have shown a significant reduction in white cell count and C-reactive protein following initiation of EVT treatment [ 12 , 20 , 25 , 30 ]. This rapid source control helps to stabilize patients who are critically ill at the onset of EVT treatment, thus reducing the need for intensive care support, which is a major advantage of the approach [ 27 ].…”