VACStent therapy for treatment of esophageal transmural defects: early experience in a tertiary hospital

Aims Endoscopic treatment has significantly improved the prognosis of patients with esophageal transmural defects. The VACStent has recently been introduced as a novel treatment option, combining the benefits of the two previously established techniques: the intraluminal stent and the endoscopic vacuum therapy. It promotes drainage of the cavity without occluding the esophageal lumen, thus allowing for oral intake. The aim of this study was to describe the first experience with the VACStent for the treatment of esophageal transmural defects in a tertiary hospital.

Methods Single-center retrospective case series conducted at a tertiary hospital in Spain. All patients with esophageal transmural defects treated with VACStent since the introduction of the technique were included (from August 2023 to April 2024).

Results A total of 7 patients were included. One patient required discontinuation of the treatment on the third day due to poor tolerance, presenting with nausea and sialorrhea. Data from the 6 patients who completed the treatment were analysed. Five patients had anastomotic leakage after esophageal resection and one patient had Boerhaave Syndrome. Technical success rate was 100%, although the removal of the VACStent was difficult on several occasions due to its strong adherence to the mucosa. Regarding the 5 patients with anastomotic dehiscence, 2 VACStents were placed in each, with a median of 14 (IQR 13-16) days of treatment course, achieving successful closure of the defect in 4 patients (80%). The patient who did not respond to treatment died from a sepsis secondary to an esophagopleural fistula and multiple associated complications. As for the patient with Boerhaave syndrome, 3 VACStents were required, achieving successful closure of the defect after 21 days of treatment. Oral intake was possible in all patients, except in one being under orotracheal intubation. During median 5 (IQR 3-7) months follow-up, one patient developed an anastomotic stricture. No other adverse events were observed.

Conclusions The VACStent appears to be a technically feasible, well-tolerated, effective, and safe therapy for the treatment of esophageal transmural defects.

Publication History

Article published online:
27 March 2025