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

Muhammad Aziz; Hossein Haghbin; Sachit Sharma; Simcha Weissman; Saad Saleem; Wade Lee-Smith; Abdallah Kobeissy; Ali Nawras; Yaseen Alastal

doi:10.1055/a-1508-5947

Endoscopy International Open, Inhaltsverzeichnis

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

Review

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

Authors

Muhammad Aziz

¹Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
Hossein Haghbin

²Department of Internal Medicine, University of Toledo, Toledo, Ohio, United States
Sachit Sharma

³Department of Internal Medicine, Promedica Toledo Hospital, Toledo, Ohio, United States
Simcha Weissman

⁴Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
Saad Saleem

⁵Department of Internal Medicine, Sunrise Hospital and Medical center, Las Vegas, Nevada, United States
Wade Lee-Smith

⁶Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, United States
Abdallah Kobeissy

¹Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
Ali Nawras

¹Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
Yaseen Alastal

¹Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States

Abstract

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.

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Referenzen

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