Post written by Samuel Han, MD, MS, from the Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA, and Mohit Girotra, MD, FASGE, and the Digestive Health Institute, Swedish Medical Center, Seattle, Washington, USA.

The goal of this Technology Status Evaluation Report was to discuss the indications for performing endoscopic vacuum therapy (EVT) and outline various techniques for performing EVT. 

It was important to provide this report given the increasing number of studies addressing the safety and efficacy of EVT. Originally, EVT was designed to treat postsurgical adverse events (eg, esophageal leaks). Its use is growing despite lack of commercially available equipment to perform this procedure.

As numerous studies have demonstrated, EVT offers an intensive-yet-effective salvage treatment option for leaks, perforations, and fistulae that can be performed with commonly available devices and instruments in medical centers. We therefore sought to develop a practical guide to endoscopists on how to perform EVT, when to use it, and which situations to avoid treating with EVT.

We present a synopsis of the success and safety of EVT for its primary indications, namely postesophagectomy leaks, postbariatric surgery leaks, colorectal anastomotic leaks, and upper GI perforations. We also highlight that performing EVT is quite labor-intensive, requiring serial endoscopic sponge exchanges every 3 to 5 days for a total of 2 to 3 weeks, necessitating long hospital stays as well.

Nevertheless, the relatively high success rates, particularly as a salvage option, bring attention to the need for therapeutic endoscopists and surgeons to be cognizant of this treatment modality. Randomized trials are needed to compare EVT with other treatment options (ie, surgery, endoscopic suturing, stent placement) to determine its cost-effectiveness, and further innovations are needed for widespread adoption.

Example of a ready-made endoscopic vacuum therapy kits. A, A polyurethane sponge overlying a fully covered metal stent (VacStent GI; VAC Stent GmbH, Fulda, Germany). B, Premade polyurethane sponge (Endo-SPONGE; B. Braun, Melsungen, Germany) connected to a drainage tube. (Images provided courtesy of Möller Medical and Braun.)

Visit iGIE’s Facebook, X/Twitter, and YouTube accounts for more content from the ASGE peer-reviewed journal that launched in December 2022.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.