Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis

  • Ishaan Vohra (Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria) ;
  • Harishankar Gopakumar (Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria) ;
  • Neil R. Sharma (Parkview Cancer Institute, Advanced Interventional Endoscopy & Endoscopic Oncology (IOSE) Division, GI Oncology Program) ;
  • Srinivas R. Puli (Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria)
  • Received : 2023.11.06
  • Accepted : 2024.03.03
  • Published : 2025.01.30
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Abstract

Background/Aims: Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a meta-analysis of the available data on the clinical success rate of EVAC. Methods: Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. Results: In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. Conclusions: This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

Keywords

References

  1. Bludau M, Hölscher AH, Herbold T, et al. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc 2014;28:896–901. https://doi.org/10.1007/s00464-013-3244-5
  2. Loske G, Schorsch T, Müller C. Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy 2011;43:540–544. https://doi.org/10.1055/s-0030-1256345
  3. Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device: a review. Am J Clin Dermatol 2005;6:185–194. https://doi.org/10.2165/00128071-200506030-00005
  4. Livingstone I, Pollock L, Sgromo B, Mastoridis S. Current status of endoscopic vacuum therapy in the management of esophageal perforations and post-operative leaks. Clin Endosc 2021;54:787–797. https://doi.org/10.5946/ce.2021.240
  5. Brangewitz M, Voigtländer T, Helfritz FA, et al. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy 2013;45:433–438. https://doi.org/10.1055/s-0032-1326435
  6. Tavares G, Tustumi F, Tristão LS, et al. Endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy: a systematic review and meta-analysis. Dis Esophagus 2021;34:doaa132. https://doi.org/10.1093/dote/doaa132
  7. Aziz M, Haghbin H, Sharma S, et al. Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: systematic review and meta-analysis. Endosc Int Open 2021;9:E1371–E1380. https://doi.org/10.1055/a-1508-5947
  8. Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 2012;5:52. https://doi.org/10.1186/1756-0500-5-52
  9. Harbord RM, Egger M, Sterne JA. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 2006;25:3443–3457. https://doi.org/10.1002/sim.2380
  10. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088–1101. https://doi.org/10.2307/2533446
  11. Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 2001;323:101–105. https://doi.org/10.1136/bmj.323.7304.101
  12. Loske G, Schorsch T, Müller C. Endoscopic vacuum sponge therapy for esophageal defects. Surg Endosc 2010;24:2531–2535. https://doi.org/10.1007/s00464-010-0998-x
  13. Laukoetter MG, Mennigen R, Neumann PA, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 2017;31:2687–2696. https://doi.org/10.1007/s00464-016-5265-3
  14. Heits N, Stapel L, Reichert B, et al. Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg 2014;97:1029– 1035. https://doi.org/10.1016/j.athoracsur.2013.11.014
  15. Möschler O, Nies C, Mueller MK. Endoscopic vacuum therapy for esophageal perforations and leakages. Endosc Int Open 2015;3:E554–E558. https://doi.org/10.1055/s-0034-1392568
  16. Min YW, Kim T, Lee H, et al. Endoscopic vacuum therapy for postoperative esophageal leak. BMC Surg 2019;19:37. https://doi.org/10.1186/s12893-019-0497-5
  17. Kuehn F, Janisch F, Schwandner F, et al. Endoscopic vacuum therapy in colorectal surgery. J Gastrointest Surg 2016;20:328–334. https://doi.org/10.1007/s11605-015-3017-7
  18. Schorsch T, Müller C, Loske G. Endoscopic vacuum therapy of perforations and anastomotic insufficiency of the esophagus. Chirurg 2014;85:1081–1093. https://doi.org/10.1007/s00104-014-2764-4
  19. Still S, Mencio M, Ontiveros E, et al. Primary and rescue endoluminal vacuum therapy in the management of esophageal perforations and leaks. Ann Thorac Cardiovasc Surg 2018;24:173–179. https://doi.org/10.5761/atcs.oa.17-00107
  20. Mencio MA, Ontiveros E, Burdick JS, et al. Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience. Surg Endosc 2018;32:3349–3356. https://doi.org/10.1007/s00464-018-6055-x
  21. Schorsch T, Müller C, Loske G. Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc 2013;27:2040–2045. https://doi.org/10.1007/s00464-012-2707-4
  22. Leeds SG, Mencio M, Ontiveros E, et al. Endoluminal vacuum therapy: how I do it. J Gastrointest Surg 2019;23:1037–1043. https://doi.org/10.1007/s11605-018-04082-z
  23. Bludau M, Fuchs HF, Herbold T, et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc 2018;32:1906–1914. https://doi.org/10.1007/s00464-017-5883-4
  24. Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg 2014;208:536–543. https://doi.org/10.1016/j.amjsurg.2014.05.011
  25. Crestanello JA, Deschamps C, Cassivi SD, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 2005;129:254–260. https://doi.org/10.1016/j.jtcvs.2004.10.024
  26. Lampridis S, Mitsos S, Hayward M, et al. The insidious presentation and challenging management of esophageal perforation following diagnostic and therapeutic interventions. J Thorac Dis 2020;12:2724–2734. https://doi.org/10.21037/jtd-19-4096
  27. Willingham FF, Buscaglia JM. Endoscopic management of gastrointestinal leaks and fistulae. Clin Gastroenterol Hepatol 2015;13:1714– 1721. https://doi.org/10.1016/j.cgh.2015.02.010
  28. Bartell N, Bittner K, Kaul V, et al. Clinical efficacy of the overthe-scope clip device: a systematic review. World J Gastroenterol 2020;26:3495-3516. https://doi.org/10.3748/wjg.v26.i24.3495
  29. van Halsema EE, van Hooft JE. Clinical outcomes of self-expandable stent placement for benign esophageal diseases: a pooled analysis of the literature. World J Gastrointest Endosc 2015;7:135–153. https://doi.org/10.4253/wjge.v7.i2.135
  30. Plum PS, Herbold T, Berlth F, et al. Outcome of self-expanding metal stents in the treatment of anastomotic leaks after Ivor Lewis esophagectomy. World J Surg 2019;43:862–869. https://doi.org/10.1007/s00268-018-4832-2
  31. Scognamiglio P, Reeh M, Karstens K, et al. Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis. Endoscopy 2020;52:632–642. https://doi.org/10.1055/a-1149-1741
  32. do Monte Junior ES, de Moura DT, Ribeiro IB, et al. Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: systematic review and meta-analysis. Dig Endosc 2021;33:892–902. https://doi.org/10.1055/s-0040-1704111
  33. Schubert D, Scheidbach H, Kuhn R, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005;61:891–896. https://doi.org/10.1016/S0016-5107(05)00325-1