Endoscopic vacuum therapy plugs leaks, perforations in upper GI tract

Use of endoscopic vacuum therapy (EVT), a new technique for closing upper gastrointestinal (UGI) defects, results in the closure of defects, such as anastomotic leak and perforations of the upper digestive tract, with only a few serious adverse events (AEs), a study has shown.

This prospective cohort study examined the efficacy and safety of EVT for the resolution of UGI defects and to explore the factors associated with EVT failure and in-hospital mortality. The authors assessed all consecutive EVT procedures from 19 Spanish hospitals in the national registry between November 2018 and March 2022.

Overall, 102 patients were included, of whom 89 had anastomotic leaks and 13 had perforations. Eighty-four patients (82 percent) achieved closure of the defect. Only six patients (5.9 percent) experienced EVT-related AEs. The in-hospital mortality rate was 12.7 percent, with six patients (5.9 percent) dying due to EVT failure and one (0.9 percent) because of a fatal AE.

Time from diagnosis of the defect to EVT initiation independently predicted EVT failure (odds ratio [OR], 1.03, 95 percent confidence interval [CI], 1.01‒1.05; p=0.005). Moreover, EVT failure (OR, 24.5, 95 percent CI, 4.5‒133; p=0.001) and development of pneumonia after EVT (OR, 246.97, 95 percent CI, 11.15‒472.58; p=0.0001) independently predicted in-hospital mortality.

“The early use of EVT improves the efficacy of this technique,” the authors said.