ENDOSCOPIC VACUUM THERAPY FOR UPPER GASTROINTESTINAL LEAKS AND PERFORATIONS: ANALYSIS FROM A MULTICENTER SPANISH REGISTRY
Momblan Dulce, Gimeno Garcia Antonio-Z, Busquets David, Juzgado Diego, García Lledó Javier, Ferrero Esther, Tejedor-Tejada Javier, Junquera Félix, Díaz-Tasende José, Moris Maria, Rodriguez de Santiago Enrique, Gornals Joan, Garrido Carmen, Gonzalez-Vazquez Santiago, Guarner-Argente Carlos, Repiso Alejandro, Esteban Jose Miguel, Loras Carme, Seoane Agustín, Fernández-Simon Alejandro, Cordova Guevara Henry, Ibarzabal Ainitze, Morales Xavier, Curell Anna, Cardenas Andrés, Ríos José, de Lacy Antonio Maria, Sendino Oriol- Gastroenterology
- Hepatology
ABSTRACT
Background:
Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated to EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality.
Methods:
This is a prospective cohort study in which consecutive EVT procedures for treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022.
Results:
We included 102 patients: 89 anastomotic leakages and 13 perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events (AE) related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal AE. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (OR=1.03, 95% CI 1.01; 1.05, p=0.005). EVT failure (OR=24.5, 95% CI 4.5; 133, p=0.001) and the development of a pneumonia after EVT (OR= 246.97, 95% CI 11.15; 5472.58, p=0.0001) were independent predictors of in- hospital mortality.
Conclusions:
Endoscopic vacuum therapy is safe and effective in cases of anastomotic leakage and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.