Endoscopic vacuum therapy for the management of upper GI leaks and perforations: a multicenter retrospective study of factors associated with treatment failure (with video)

Abstract Background and Aims The optimal management of upper gastrointestinal (UGI) leaks and perforations remains controversial. Endoscopic vacuum therapy (EVT) is a new alternative endoscopic treatment that has recently shown a high rate of successful closure of UGI leaks and perforations. However, only few reports have been made on the factors that affect clinical success rates. Methods Four referral hospitals participated in this retrospective multicenter study. Between September 2015 and February 2020, 119 patients who underwent EVT for a UGI perforation or leak were included. We retrospectively evaluated the clinical outcomes of EVT and the factors associated with EVT failure. Neoadjuvant treatments included chemotherapy, radiotherapy, or chemoradiotherapy before surgery; and intraluminal method meant that the sponge was placed directly onto the defect within the lumen of UGI tract. Results Among the 119 patients, 84 showed clinical success (70.6%). Eighty-nine (74.8%) patients underwent EVT as primary therapy, and 30 patients as rescue therapy. On multivariate analysis, neoadjuvant treatment and the intraluminal method were significant independent risk factors for EVT failure. During the follow-up period (median, 8.46 months), stenosis occurred in 22 patients (18.5%). The overall survival rate of the EVT success group was significantly higher than that of the EVT failure group. Twenty-two patients died due to non-EVT-related causes, and 7 patients died due to leakage-related adverse events. No death was caused by the EVT itself. Conclusion Endoscopic vacuum therapy is a promising treatment method for UGI leaks and perforations. Further studies are needed to establish the indications for successful EVT.