Post-EndoVAC™ stenosis in the treatment of spontaneous and iatrogenic esophageal anastomotic fistulas: a prospective single-center case series

Aims EndoVAC therapy is a novel endoscopic treatment that applies continuous negative pressure through a sponge connected to a vacuum system. This approach promotes drainage, stimulates granulation tissue, and accelerates healing. The main indications include post-operative anastomotic fistulas, spontaneous or iatrogenic dehiscences, and perforations. Observational and case series studies, though not randomized controlled trials, report success rates above 80%, often reducing the need for additional surgeries and lowering septic complications. However, drawbacks include the necessity of repeated endoscopic procedures and the risk of pressure-induced injuries or damage from prolonged sponge application.

Methods Data was prospectively collected from a digital database at the Gastroenterology and Digestive Endoscopy Department of “G. Mazzini” Hospital in Teramo, covering the period from January 2023 to October 2024. VacStent used constant pressure setting of -125 mmHg and it was placed at last two times and replaced approximately every 7 days [1] [2] [3].

Results We enrolled six male patients, with a mean age of 75 and an average ASA score of 3. Four patients with iatrogenic anastomotic fistulas, two patients with spontaneous fistulas. For only one patient esophageal metallic stent were performed before VacStent placement. The average time from diagnosis of anastomotic fistula/dehiscence to VacStent insertion was 13.75 days. All patients received at least two treatments (one patient received three), with stent replacement every 7 days. The total treatment duration averaged 15 days. In 5/6 patients esophageal metal stent was performed after VacStent treatment to consolidate results, 1/6 patient required only nasogastric tube. Two patients achieved resolution after 15 days of treatment, one after 20 days. Overall success rate was 50% (3/6 patients). There was no procedure-related mortality. Esophageal stricture occurred in 33% (2/6 patients) after an average of 2.5 months, treated endoscopically, such as pneumatic dilation and esophageal stenting [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34].

Conclusions EndoVAC is a safe, promising, and effective technique to avoid surgery. All post EndoVac complication can be retreated endoscopically. Further large-scale studies and randomized trial are essential to drawn up a protocol for optimal timing, indications, and strategies for preventing and managing potential complications

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

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