Endoscopic vacuum assisted closure (E-VAC) of upper gastrointestinal leakages

Abstract

Objectives

Endoscopic vacuum-assisted closure (E-VAC) of leaks of the upper gastrointestinal tract is an increasingly applied endoscopic technique. Data on indication, clinical success, complications and prognostic factors are still sparse.

Methods

Patients treated with E-VAC between 2012 and 2019 at a tertiary referral center have been retrospectively analyzed.

Results

Overall, 116 patients treated with E-VAC were identified. Indication for E-VAC placement was postoperative leakage in 94/116 (81%), iatrogenic perforations 7/116 (6%) and others 15/116 (13%). In 92/116 (79%) of the patients E-VAC therapy showed successful wound closure. The first E-VAC after detection of insufficiency was significantly more often placed intracavitary in patients with E-VAC failure (p = .031). There was a trend for longer intensive care unit treatment for patients with E-VAC failure (p = .069). Complications occurred significantly more often in patients with E-VAC failure (p = .009). Platelet count was significantly higher in patients with E-VAC success at day of insufficiency detection (257/Thsd/µL (interquartile range [IQR], 185–362) vs. 195 (IQR, 117–309); p = .039). Platelet count (375 Thsd/µL (IQR, 256–484) vs. 190 (IQR, 129–292)), hemoglobin (9.5 g/dL (IQR, 8.8–10.1) vs. 8.7 g/dL (IQR, 8.15-9.35)) and C-reactive protein level (79 mg/L (IQR, 39.7-121.9) vs. 152 mg/L (IQR, 73.7-231)) at day 14 differed significantly. The 30 days mortality rate was 33.3% (8/24) in E-VAC failure compared with 2.2% in patients with E-VAC success (p = .001).

Conclusions

E-VAC is an emerging highly effective interventional endoscopic technique for gastrointestinal wound closure even in highly selected patients.

Keywords:

• Endoscopic vacuum-assisted closure( E-VAC)
• esophageal perforations
• postoperative leakage
• gastrointestinal leakages
• esophagogastrostomies

Disclosure statement

All authors have nothing to declare.

Author contributions

TB: collection of data, analysis, and preparation of manuscript. NW: collection of data. MW: collection of data and preparation of manuscript. MMK: collection of data and statistical analysis. BH: collection of data. HW: writing of manuscript and critical revision. TV: concept and design of the study, writing of manuscript and statistical analysis