Post written by Jun Chul Park, MD, PhD, from the Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Upper GI leaks and perforations lead to serious conditions associated with high morbidity and mortality. The optimal method for managing these patients remains controversial.

Although surgery is a treatment option, it is associated with a mortality rate of 12% to nearly 50%, depending on the organ. Therefore, non-invasive endoscopic treatment has recently been preferred over surgery.

Recently, endoscopic vacuum therapy (EVT) has shown excellent efficacy in managing UGI leaks and perforations. However, few reports have focused on the factors associated with successful EVT. Even in these studies, the number of enrolled patients for analyses was very small. Therefore, in the current study, we investigated the risk factors for failed EVT in a larger number of patients from 4 referral hospitals.

Previous studies have shown that the clinical success rate of EVT is too broad, and EVT is not always successful. One of the reasons is that various factors can affect the outcome of the procedure and cases, with a high probability of failure and success analyzed together. Failure of the primary treatment for these patients can have a fatal impact on the prognosis, so it is most important to perform this kind of treatment on selected patients from the beginning.

We found that neoadjuvant treatment before the procedure and the intraluminal EVT method were significant independent risk factors for vacuum therapy. In addition, the overall survival rate of the vacuum therapy success group was significantly higher than that of the failure group. EVT itself is a relatively safe procedure. Seven patients died due to leakage-related adverse events. However, no death was caused by the vacuum therapy itself.

Based on current and previous studies, I think EVT is a promising treatment method for UGI leaks and perforations. However, we must keep in mind that previous neoadjuvant treatment and the intraluminal method of EVT could affect a poor prognosis prior to the procedure.

Overall survival according to failure of EVT. EVT, Endoscopic vacuum therapy.

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