Endoscopy 2020; 52(S 01): S34-S35
DOI: 10.1055/s-0040-1704111
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 Advances in endoluminal endoscopy Liffey Meeting Room 2
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC STENTING VERSUS ENDOSCOPIC VACUUM THERAPY IN THE MANAGEMENT OF UPPER GASTROINTESTINAL TRANSMURAL DEFECTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

ES do Monte Junior
1   University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
DTH de Moura
1   University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
IB Ribeiro
1   University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
S Singh
2   West Virginia University Health Sciences Center, Division of Gastroenterology, Charleston, United States of America
,
M Coronel
1   University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
C Thompson
3   Hepatology and Endoscopy, Brigham and Women’s Hospital, Division of Gastroenterology, Boston, United States of America
,
EGH de Moura
1   University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Surgical management of gastrointestinal (GI) transmural defects like perforations, leaks, and fistulas are associated with high morbidity and mortality rates. Several endoscopic techniques are now available, and endoscopy has become the first-line approach to manage these conditions. Among the endoscopic therapies, placement of a self-expanding metal stents (SEMS) is the most widely used therapy. Whereas, endoscopic vacuum therapy (EVT) has recently emerged as a safe and effective tool that promotes healing via macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to compare SEMS and EVT for the management of upper GI transmural defects.

Methods This systematic review was conducted according to the PRISMA guidelines. Searches were performed without any language restrictions using MEDLINE, EMBASE, Central Cochrane, Latin American, and Caribbean Health (LILACS) databases from their dates of inception to October 2019. Gray literature, as well as manual searches, were also performed. Studies comparing SEMS and EVT to treat upper GI transmural defects were included.

Results Out of a total of 5,900 citations, five studies with a total of 274 patients met the inclusion criteria and were eligible for analysis. All included studies were observational. Successful fistula closure was significantly higher in the EVT group, corresponding to a 21% higher fistula closure rate as compared to SEMS (RD 0.21 (95%CI 0.10 - 0.32); p-value 0.0003). EVT was also associated with an 11% statistically significant lower mortality as compared SEMS group (RD 0.11 (95%CI 0.20 - 0.03); p-value 0.009). However, the incidence of adverse events, hospital stay, and duration of treatment showed no statistically significant difference between the two groups (p-value >0.05).

Conclusions EVT is superior to SEMS for fistula closure in the upper GI tract. Moreover, EVT also resulted in a decrease in mortality compared to SEMS.