Case Series: Success of Endoscopic Vacuum Therapy (E-VAC) with Budget-Friendly Devices in Upper GI Complications

An adapted version of endoscopic vacuum therapy (E-VAC), termed "low-cost VAC," is made using gauze or an open-pore sponge covered with perforated sterile plastic. We present a case series of five patients with various presentations of postoperative leaks and fistulas treated with the "low-cost VAC" method: 1) A 67-year-old female with squamous cell carcinoma underwent esophagectomy. Postoperatively, she developed a complex fistula (esophagus-pleuro-mediastinal-cutaneous). E-VAC therapy required five placements and replacements, leading to complete closure after 50 days. A complication of esophageal stenosis was resolved with balloon dilation. 2) A 77-year-old male with esophageal adenocarcinoma had esophagogastric anastomosis dehiscence. A mega-stent and E-VAC device were placed, resulting in successful closure after 75 days. 3) A 60-year-old female experienced extensive gastric suture dehiscence after esophagectomy for squamous cell carcinoma. E-VAC therapy achieved closure with two placements in 46 days. 4) A 61-year-old male with gastric adenocarcinoma had esophageal-jejunal anastomosis dehiscence. E-VAC therapy closed the defect with one placement in 15 days. 5) A 59-year-old male with gastric neuroendocrine tumors underwent total gastrectomy and developed multiple esophageal-jejunal anastomosis dehiscences. E-VAC therapy closed the defects with two placements over 30 days [1].

This technique is feasible, cost-effective, and readily available, providing results comparable to other drainage systems. It serves as a validated option where access to commercial devices is limited.

Publication History

Article published online:
27 March 2025

• References

• 1 Cereatti F. et al. Endoscopic management of gastrointestinal leaks and fistulae: What option do we have? WJG. 2020