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
