Systematic review and meta-analysis: endoscopic vacuum therapy (evt) versus self-expandable metal stent (sems) for anastomotic leaks after upper gastrointestinal surgery

Aims Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscences includes Self-Expandable Metal Stents (SEMS) and Endoscopic Vacuum Therapy (EVT). The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery

Methods A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for treatment of leaks after upper gastro-intestinal surgery, for malignant or benign pathology. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori- defined subgroup analysis for the oncologic surgery group

Results Eight retrospective studies with a total of 357 patients were eligible. Overall, EVT group showed higher success rate (odd ratio [OR] 2.58, 95% CI 1.43-4.66), lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08-6.71), shorter treatment duration (pmd -9.18, 95% CI -17.05- -1.32) lower short-term complication (OR 0.35, 95% CI 0.18-0.71), and mortality rates (OR 0.47, 95% CI 0.24-0.92), compared to stenting. In oncologic surgery subgroup analysis, no differences in success rate were found (OR 1.59, 95% CI 0.74-3.40, I²=0%)

Conclusions Overall, EVT has revealed to be more effective and less-burdened complications compared to stenting. At oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data are needed.

Publication History

Article published online:
14 April 2023