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CC BY 4.0 · Endoscopy 2023; 55(09): 859-864
DOI: 10.1055/a-2042-6707
Innovations and brief communications

Endoscopic vacuum therapy for esophageal perforation: a multicenter retrospective cohort study

Joanna Luttikhold‡   ‡
1   Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, and Department of Upper Abdominal Diseases, Stockholm, Sweden
,
Lisanne M. D. Pattynama  ‡   ‡
2   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
3   Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
4   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
,
Stefan Seewald
5   Centre of Gastroenterology, Klinik Hirslanden, Zürich, Switzerland
,
Stefan Groth
5   Centre of Gastroenterology, Klinik Hirslanden, Zürich, Switzerland
,
Bernhard K. Morell
6   Department of Gastroenterology and Hepatology, Universitätsspital, Zürich, Switzerland
7   Department of Gastroenterology and Hepatology, Stadtspital Zürich, Zürich, Switzerland
,
Christian A. Gutschow
8   Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
,
Satoshi Ida
1   Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, and Department of Upper Abdominal Diseases, Stockholm, Sweden
,
Magnus Nilsson
1   Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, and Department of Upper Abdominal Diseases, Stockholm, Sweden
,
Wietse J. Eshuis
3   Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Roos E. Pouw
2   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
4   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT05606822 Type of study: Retrospective observational
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Referred to by:

Author commentary on Joanna Luttikhold et al.Endoscopy 2023; 55(09): v28-v28
DOI: 10.1055/a-2071-9048

See also:

Endoscopic vacuum therapy for esophageal perforations: is it risk effective for every size of defect?Endoscopy 2023; 55(10): 971-971
DOI: 10.1055/a-2070-5524

Abstract

Background Endoscopic vacuum therapy (EVT) is a novel treatment for esophageal perforations. This study aimed to describe initial experience with EVT of esophageal perforations due to iatrogenic cause, Boerhaave syndrome, or other perforations not related to prior upper gastrointestinal surgery.

Methods Data from patients treated with EVT for esophageal perforation at five hospitals in three European countries, between January 2018 and October 2021, were retrospectively collected. The primary end point was successful defect closure by EVT, with or without the use of other endoscopic treatment modalities. Secondary end points included mortality and adverse events.

Results 27 patients were included (median age 71 years). The success rate was 89 % (24/27, 95 %CI 77–100). EVT failed in three patients: two deceased during EVT (septic embolic stroke, pulmonary embolism) and one underwent esophagectomy due to a persisting defect. Two adverse events occurred: one iatrogenic defect expansion during sponge exchange and one hemorrhage during sponge removal. Median treatment duration was 12 days (interquartile range [IQR] 6–16) with 1 sponge exchange (IQR 1–3).

Conclusion EVT is a promising organ-preserving treatment for esophageal perforations, with a success rate of 89 %. More experience with the technique and indications will likely improve success rates.

‡ Co-first authors.




Publication History

Received: 28 September 2022

Accepted after revision: 24 February 2023

Accepted Manuscript online:
24 February 2023

Article published online:
20 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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