Management of Upper Gastrointestinal Tract Leaks Using Endoluminal Vacuum Therapy: 10-years’ Experience of a Specialist Esophago-gastric Center

ABSTRACT

Introduction: Management of upper gastrointestinal (UGI) leaks is challenging, especially in patients with delayed presentation and established sepsis. Endoluminal vacuum therapy (EVT) is an emerging treatment strategy which may reduce morbidity and mortality compared to traditional treatments in this patient group. We report the outcomes for patients with UGI leaks treated with EVT in a tertiary UK hospital over a 10-year period. Methods: Between April 2011 and February 2021, 63 patients with UGI leaks from different causes were treated with EVT using an ad-hoc endoluminal vacuum device (EVD). Information related to treatment and outcome was recorded prospectively. Results: Patients had a median age of 67 years (25-92), and mean Apache II score of 20.7 (6-36) at the time of leak diagnosis. The cause of the leak was anastomotic (n=23;37%), iatrogenic (n=20;32%), spontaneous (n=19;30%), and traumatic (n=1;2%). Forty-seven (75%) leaks were oesophageal, 12 (19%) gastric, 2 (3%) duodenal, and 1 (2%) pharyngeal. The median number of EVD changes required to heal the leak was 9 (1-27), and median length of hospital stay was 31 days (1-196). Successful resolution of the leak occurred in 55 (87%) patients. Eight (13%) patients died during treatment. There were no complications related to insertion of the EVD. Eight (13%) patients had complications during treatment which required further intervention including bleeding (n=4;6%), stroke (n=1;2%), pulmonary embolus (n=1;2%), myocardial infarction (n=1;2%) and COVID-19 (n=1;2%). Conclusion: EVT is safe, and can be used to successfully treat UGI leaks from a disparate range of leak causes in critically unwell patients. Further studies are required to develop a standardized procedure to enable broader adoption of EVT in this group of patients.