Endoscopy 2025; 57(S 02): S192
DOI: 10.1055/s-0045-1805478
Abstracts | ESGE Days 2025
Moderated poster
Therapeutic endoscopy in the upper GI tract 03/04/2025, 10:30 – 11:30 Poster Dome 2 (P0)

The use of VacStent for the treatment upper gastro-esophageal leaks after surgery: a multicenter prospective study

H Bertani
1   Gastroenterology and Endoscopy Unit-AOU Policlinico di Modena, Modena, Italy
,
F P Zito
2   Ospedale Cardarelli – Edificio E, Napoli, Italy
,
S Mangiafico
3   Azienda Ospedaliero-Universitaria Policlinico G.Rodolico – San Marco, Catania, Italy
,
R Manta
4   USL 6 Livorno, Livorno, Italy
,
S Cocca
5   Azienda Ospedaliero – Universitaria di Modena, Modena, Italy
,
G Grande
6   Gastroenterology and Digestive Endoscopic Unit;Azienda Ospedaliero Univeristaria of Modena, Modena, Italy
,
M Lupo
5   Azienda Ospedaliero – Universitaria di Modena, Modena, Italy
,
F Pigò
5   Azienda Ospedaliero – Universitaria di Modena, Modena, Italy
,
S Russo
5   Azienda Ospedaliero – Universitaria di Modena, Modena, Italy
,
R Conigliaro
7   Gastroenterology and Digestive Endoscopy Unit, University Hospital Modena, Italy
› Author Affiliations
› Further Information
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Aims Anastomotic leak (AL) is the most life-threatening complication after gastro-esophageal surgery, and its treatment lacks standardization. Endoscopic vacuum treatment (EVT) has emerged as a feasible option by fast clearing the leak and promoting granulation tissue development. The VAC-Stent combines a fully covered SEMS with an integrated EVT sponge, combining SEMSs' ability to exclude defects and maintain the patency of the esophageal lumen with EVT's ability to aspirate secretions and promote the formation of granulation tissue, as well as easier deployment and shorter exchange times than standard vac-therapy. Initial data by studying effectiveness, outcomes, and problems in individuals who have had gastro-esophageal surgery are under evaluation [1] [2].

Methods This pilot research is a retrospective examination of a prospectively collected case series from four Italian institutions of patients treated with the VACStent as the initial treatment for ALs following gastro-esophageal surgery for benign or oncological indications.

Results From January 2023 to September 2024, 30 pts (20M, 10F) with AL were treated with 74 VAC Stents positioned with a medium of 2.4 stent/patient. 20 patients underwent surgery for oncological indications, 6 for complications after bariatric surgery. In 75% of patients the Vacuum pressure was 120 mmHg for the first 24 hrs then dropped to 100 mm Hg for the next 4 days until replacement. After 5 days from VAC stent positioning a rapid improvement of clinical sign, lab test and endoscopic features of leak was recorded. In 90% of patient a full recovery of mural defect was achieved at follow up endoscopy at 2 months but 2 patients died for complications of sepsis without leak resolution.

Conclusions VacStent procedure is a promising technique which combine the covered metal stent with vac therapy in AI leak. More studies are needed to clarify pressure and timing of switching to standard therapy.



Publication History

Article published online:
27 March 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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