Elsevier

Gastrointestinal Endoscopy

Volume 95, Issue 2, February 2022, Pages 281-290
Gastrointestinal Endoscopy

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

https://doi.org/10.1016/j.gie.2021.09.018Get rights and content

Background and Aims

The optimal management of upper GI (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 the intraluminal method meant that the sponge was placed directly onto the defect within the lumen of UGI tract.

Results

Among 119 patients, 84 showed clinical success (70.6%). Eighty-nine patients (74.8%) 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 because of non–EVT-related causes, and 7 patients died because of leakage-related adverse events. No death was caused by the EVT itself.

Conclusions

EVT is a promising treatment method for UGI leaks and perforations. Further studies are needed to establish the indications for successful EVT.

Section snippets

Patients

Four referral hospitals participated in this retrospective, multicenter study. Between September 2015 and February 2020, 119 patients who underwent EVT for UGI perforation or leak at 4 tertiary hospitals (Severance Hospital, Samsung Medical Center, Incheon St Mary’s Hospital, and Gangnam Severance Hospital) were included in this study. Demographic data, including age, sex, comorbidities, and cause of perforation or leak, were retrospectively obtained from medical records. Clinical data, such as

Patient characteristics

One hundred nineteen patients with a UGI perforation or leak underwent EVT. Their baseline characteristics are shown in Table 1. The etiologies for EVT were anastomosis site leak, iatrogenic perforation, and others. Among the patients who underwent EVT, 113 had undergone surgery before EVT. The indications for surgery were esophageal cancer, gastric cancer, both esophageal and gastric cancer, and benign disease. Also, 6 patients had not undergone surgery before EVT. The indications for EVT were

Discussion

In this study, neoadjuvant treatment and the intraluminal method were independent risk factors for EVT failure. Several reports have shown the effectiveness of EVT for the treatment of UGI leaks and perforations.19,24,25,32,33 A previous meta-analysis19 reported that healing of the perforation occurred in 66.7% to 100% of cases treated with EVT, with an overall mortality rate of 0% to 12.8%.24,25,32,33 However, the included studies were limited to case series and retrospective cohort studies

Acknowledgment

We thank Nak-Hoon Son, PhD, for his comments on the statistical analysis and Dong Su Jang, PhD, for medical illustrations for this article.

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    DISCLOSURE: All authors disclosed no financial relationships.

    If you would like to chat with an author of this article, you may contact Dr Park at [email protected].

    Drs Jung and Huh contributed equally to this article.

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