Aims Esophageal or gastric perforation is associated with systemic inflammatory response
syndrome (SIRS), which can lead to multi-organ dysfunction and mortality in up to
50% of cases. Endoscopic vacuum therapy involves the use of a catheter with a sponge
attached to its distal end, connected to a machine that applies negative pressure,
allowing for continuous drainage of the perforation site and potentially promoting
healing of the transmural defect. Previous series have reported promising results,
indicating the potential effectiveness of this therapy in managing esophageal perforations.
To evaluate the efficacy of endoscopic vacuum treatment in patients with primary or
secondary gastroesophageal perforations.
Methods Single-center retrospective cohort study on patients treated for gastroesophageal
perforation between March 2019 and September 2022. The inclusion criteria for the
study were patients with gastroesophageal perforation resulting from spontaneous rupture
or iatrogenic damage (post-surgical or post-endoscopic treatment). The primary outcomes
of the study were the success rate of endoscopic therapy, the length of hospital stay,
and the specific survival at 30 and 90 days. The success rate of endoscopic therapy
was assessed by considering the treatment successful if it led to the resolution of
the fistula following vacuum endoscopic therapy. Secondary endpoints included the
need for intensive care unit (ICU) stay between the start of vacuum endoscopic therapy
and the patient's discharge.
Results 27 patients, with a mean age of 69.8 years (95% CI 65.4-74.3), including 9 (33.3%)
women, underwent endoscopic treatment with vacuum therapy for esophageal perforation.
The causes of perforation were as follows: 6 (22.2%) cases were primary (Boerhaave
syndrome), 15 (55.5%) cases were post-surgical (post-surgical anastomosis), and 6
(22.2%) cases were post-endoscopic treatment (endoscopic dilatation). Among the patients,
13 (48.1%) had previously undergone surgery for cancer, with 69.2% of them receiving
intrathoracic stomach interposition reconstruction and the remaining patients undergoing
reconstruction according to Roux-en-Y procedure. The treatment was successful in 21
(77.7%) patients, with a 14 days (9.0-24.4, 95% CI) median duration of treatment,
and 4 (3-7, 95% CI) median number of endoscopic devices used per patient. One patient
(3.7%) died within 30 days, and another one (3.7%) within 90 days. A total of 10 (38.4%)
patients required an ICU stay, and there were no readmissions within 30 days. No procedure-related
complication was reported. [1]
[2]
[3]
Conclusions In the current pilot study, the findings support the feasibility and safety of endoscopic
vacuum therapy as a treatment modality for both primary and secondary gastro-esophageal
perforations.
