VACUUM THERAPY WITH ENDOLUMINAL SPONGE: TREATMENT OF UPPER GASTROINTESTINAL TRACT PERFORATIONS AND LEAKS. WHAT ARE THE BEST INDICATIONS?

Aims Perforations (spontaneous or iatrogenic) and anastomotic leakage of gastrointestinal tract are medico-surgical emergencies responsible for high morbidity and mortality. Endoluminal sponge vacuum therapy (EVT) is an established treatment for their management. We report here our experience.

Methods This single-center observational study was conducted from November 2016 to May 2019, we included all patients with upper GI tract perforation. A polyurethane sponge was endoscopically placed either in the perforated cavity lumen or endoluminal for perforations less than 1 cm in diameter. The sponge was attached to a nasally externalized drain with a continuous aspiration.The sponge was changed every 3-4 days. The primary endpoint was defined by the complete closure of the perforation (clinical success). Secondary outcomes were technical success, number of sponge changes, 3 months morbidity and mortality and length of hospital stay.

Results Ten patients were included (7 Men), mean age 55.2 y (22-75 y). Perforation was secondary to Boerhaave syndrome (n = 4), bariatric surgery (n = 2), anti-reflux surgery (n = 1),perforated duodenal ulcer (n = 1), cervical chronic fistula (n = 1), major oncological surgery (n = 1). Technical success rate was100%. Clinical success rate was 60%: after an average 12.6 days treatment (11- 44 days). In esophageal perforations and eso-gastric anastomotic leaks, clinical success rate was 87.5%. The sponge was changed on average 4.5 times (2-10 times). Surgical treatment was required in 4 patients: 3 septic shocks and one failure after 3 sponge changes. No severe complication nor death were reported. The mean hospitalization lengh was 69.8 days (22-245 days).

Conclusions EVT appears as a safe endoscopic technique for management of perforations and anastomotic leakage of the upper gastrointestinal tract. It was effective in 2/3 of patients. EVT should be discussed in extended indications. It should be proposed as first-line treatment in esogastric anastomotic perforations or leakages.