Does the VacStent offer a paradigm shift for the endoscopic management of esophageal defects? Early insights from the largest UK experience

Aims Endoscopic vacuum therapy (EVT) is an increasingly popular option for the management of gastrointestinal transmural defects. Esophageal defects in particular are associated with prolonged hospital admissions, complex nutritional needs and ultimately high rates of morbidity and mortality. Within the esophagus conventional sponge therapy necessitates frequent exchanges and a reliance on total parental nutrition due to lumen occlusion. The VacStent GI (MicroTech) device synergistically incorporates the advantages of fully covered self-expanding metal stents (fcSEMS) while synchronously employing the principles of EVT overcoming these drawbacks.

Methods We analysed patients undergoing treatment for transmural esophageal leaks with the VacStent device between October 2023 and October 2024 at our tertiary referral centre. The primary outcome was clinical success, defined as the endoscopic and radiological evidence of defect closure. Secondary outcomes included number of stent exchanges, technical success, serious adverse device effect (SADE) and time to defect closure. Statistical analysis was performed using R (Version 4.4.1, Foundation for Statistical Computing, Vienna, Austria).

Results The VacStent GI device was implanted 24 times across 11 patients with a median age of 58 years (IQR 68-75). 64% were male. 18% (n=2) had defects secondary to Boerhaaves Syndrome, 36% (n=4) had Iatrogenic defects and 45%, (n=5) had Anastomotic leaks (1=benign, 4=malignant). Clinical success was achieved in 73% of patients with a technical success rate of 100%. Median time to defect closure following index VacStent implantation was 9 days (IQR 6-13.5) with a median of 1 VacStent exchange (IQR 0-2). The median defect size was 10mm (IQR 6-17.5). The VacStent failed in 3 patients, one patient was switched to intra-cavitary sponge therapy followed by fcSEMS insertion, the second case was treated with fcSEMS, and the final patient was treated by closing the defect with an Over the scope clip. There were no reported SADEs.

Conclusions Our experience illustrates the safety and efficacy of VacStent therapy for the treatment of transmural esophageal defects with a clinical success rate of 73%. This is typically a challenging cohort of patients who have limited treatment options. The three cases of failure in our cohort we postulate are related to the following factors: a large defect associated with a capacious cavity, and two defects located within the surgical conduit. More experience with a diverse and larger patient population will further clarify the position of VacStent in the EVT treatment paradigm.

Publication History

Article published online:
27 March 2025