Endoscopic Vacuum Therapy for Spontaneous and Iatrogenic Esophageal Perforations: A Retrospective Study

Chengcheng Christine Zhang1 *, Henrik Nienhüser2 , Christian Rupp1 , Ronald Koschny1 , Thomas Schmidt2 , Beat P Müller-Stich2 , Thilo Hackert2 , Peter Sauer1 , Markus W Büchler2 and Anja Schaible2

1 Department of Gastroenterology, Heidelberg University Hospital, Germany 2 Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Germany

^*Correspondance to: Chengcheng Christine Zhang 

 PDF  Full Text DOI: 10.25107/2474-1647.3103

Abstract

Introduction: Esophageal perforations are associated with high morbidity/mortality. Treatment of this life-threatening condition remains challenging with no consensus on the appropriate management. Endoscopic vacuum therapy represents a novel therapeutic option. This retrospective study aimed to evaluate the feasibility, effectiveness, and safety of endoscopic vacuum therapy for esophageal perforations. Methods: Twenty-seven consecutive patients with esophageal perforations were treated in our hospital, of which 7 underwent surgery (surgical repair, n=4; diversion, n=3), 1 underwent endoscopic stenting, and 19 were treated with endoscopic vacuum therapy. Results: Overall, 21 patients were treated with endoscopic vacuum therapy, including two patients following the failure of primary surgical approach. The median number of endoscopic vacuum therapy procedures per patient was 2, with a median duration of therapy of 10 days. A minor complication related to endoscopic vacuum therapy occurred in one patient (n=1/21; 4.8%), and successful closure of esophageal perforations with endoscopic vacuum therapy was achieved in 90.5% (n=19/21). Overall successful treatment of all perforations could be achieved in 77.8% of the patients (n=21/27); of the remaining six patients, five underwent a diversion, whereas one died during endoscopic vacuum therapy. The overall in-hospital mortality rate was 7.4% (n=2/27). Conclusion: Endoscopic vacuum therapy is a safe and effective approach for spontaneous and iatrogenic esophageal perforations, offers high closure rates, and can potentially reduce perforationrelated mortality.

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Cite the article

Zhang CC, Nienhüser H, Rupp C, Koschny R, Tho-mas Schmidt, Müller-Stich BP, et al. Endoscopic Vacuum Therapy for Spontaneous and Iatrogenic Esophageal Perforations: A Retrospective Study. Clin Surg. 2021; 6: 3103..