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

  • Author Footnotes
    ∗ Drs Jung and Huh contributed equally to this article.
    Da Hyun Jung
    Footnotes
    ∗ Drs Jung and Huh contributed equally to this article.
    Affiliations
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Author Footnotes
    ∗ Drs Jung and Huh contributed equally to this article.
    Cheal Wung Huh
    Footnotes
    ∗ Drs Jung and Huh contributed equally to this article.
    Affiliations
    Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Yang Won Min
    Correspondence
    Yang Won Min, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
    Affiliations
    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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  • Jun Chul Park
    Correspondence
    Reprint requests: Jun Chul Park, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
    Affiliations
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Jung and Huh contributed equally to this article.
Published:September 20, 2021DOI:https://doi.org/10.1016/j.gie.2021.09.018

      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.

      Graphical abstract

      Abbreviations:

      EVT (endoscopic vacuum therapy), SEMS (self-expanding metal stent), UGI (upper GI)
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          We congratulate Jung et al1 on their study entitled “Endoscopic vacuum therapy for the management of upper GI leaks and perforations: a multicenter retrospective study of factors associated with treatment failure (with video).” The authors report a clinical success of 70.6% in 119 consecutive patients treated with endoscopic vacuum therapy (EVT), with neoadjuvant treatment and intraluminal placement independently associated with EVT failure.
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          We have read with great interest the article by Jung et al1 assessing the efficacy of endoscopic vacuum therapy (EVT) in the treatment of upper GI leaks and perforations. The authors reported a clinical success rate of 76% in a sample size of 118 patients, the largest in EVT reports, confirming the high efficacy of this technique.2,3
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