CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(09): E1371-E1380
DOI: 10.1055/a-1508-5947

Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: Systematic review and meta-analysis

Muhammad Aziz
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
Hossein Haghbin
2   Department of Internal Medicine, University of Toledo, Toledo, Ohio, United States
Sachit Sharma
3   Department of Internal Medicine, Promedica Toledo Hospital, Toledo, Ohio, United States
Simcha Weissman
4   Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
Saad Saleem
5   Department of Internal Medicine, Sunrise Hospital and Medical center, Las Vegas, Nevada, United States
Wade Lee-Smith
6   Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, United States
Abdallah Kobeissy
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
Ali Nawras
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
Yaseen Alastal
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
› Author Affiliations


Background and study aims Esophageal defects (leaks, fistulas, and perforations) are associated with significant morbidity and mortality. Endoluminal vacuum-assisted closure (EVAC) is a novel intervention that entails the use of sponges in the defect along with negative pressure to achieve granulation tissue formation and healing and has been gaining popularity. We performed a systematic review and pooled analysis of available literature to assess the safety and effectiveness of EVAC for esophageal defects.

Patients and methods We queried PubMed/Medline, Embase, Cochrane, and Web of Science through September 25, 2020 to include all pertinent articles highlighting the safety and effectiveness profile of EVAC for esophageal defects. Pooled rates, 95 % confidence intervals (CIs), and heterogeneity (I2 ) were assessed for each outcome.

Results A total of 18 studies with 423 patients were included (mean age 64.3 years and males 74.4 %). The technical success for EVAC was 97.1 % (CI: 95.4 %–98.7 %, I2  = 0 %). The clinical success was 89.4 % (CI: 85.6 %–93.1 %, I2  = 36.8 %). The overall all-cause mortality and adverse events (AEs) noted were 7.1 % (CI: 4.7 %–9.5 %, I2  = 0 %) and 13.6 % (CI: 8.0 %–19.1 %, I2  = 68.9 %), respectively. The pooled need for adjuvant therapy was 15.7 % (CI: 9.8 %–21.6 %, I2  = 71.1 %).

Conclusions This systematic review and meta-analysis showed high rates of technical success, clinical success, and low all-cause mortality and AEs using EVAC. Although the technique is a promising alternative, the lack of comparative studies poses a challenge in making definite conclusions regarding use of EVAC compared to other endoscopic modalities, such as clips and stents.

Supplementary material

Publication History

Received: 25 January 2021

Accepted: 05 May 2021

Article published online:
16 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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