Endoluminal Vacuum-Assisted Closure (E-Vac) Therapy for Esophageal Perforation—A Case Series

Background: Esophageal perforations and postoperative leaks are a surgeon’s nightmare, when surgically repaired can frequently cause rent leak and its complications. Endoscopy-guided vacuum-assisted closure of these perforations help in continuous negative pressure to keep the area dry, form increased granulation tissue and faster chances of healing with reduced need of reintervention, sepsis, and complications.

Methods: In this series of three cases of esophageal perforation from a single center KIMS Health, Trivandrum, Kerala, India have been described, as in Table 1a. These cases were managed by the same team of Medical and Surgical Gastroenterologists, endoscopy technicians. Each session of E-Vac insertion was done under anesthesia after endotracheal intubation. Cavity was reassessed every 3 to 4 days or earlier if any discomfort or vacuum suction failure. The decision to stop the therapy was decided after a multidisciplinary evaluation and after looking for CT oral contrast leak.

Results: The outcomes of these 3 cases are described in table 1b. Among the 3 cases, 1 and 3 had successful healing of the esophageal rent with restoration to complete oral feeds over time. Case 2 has episodes of recurrent sepsis and needed continued care when bystanders chose to withdraw support. Case 1 demonstrates that having an early introduction of the E-Vac helps prevent development of complications when conventional methods of surgical repair or esophageal stenting fails. Case 2 had delay in referral to our facility hence probably had worsening sepsis and poor outcomes. Case 3 highlights the importance of introducing the vacuum as early as possible to help in keeping the wound healthy irrespective of the time and type of perforation.

Conclusion: Vacuum assisted wound healing has been an alternative method with better reconstruction of difficult wounds and increased rates of healing during primary closure. This used endoscopically has changed the approach to esophageal perforations. Further expertise in E-Vac could change algorithms along with conventional treatments.

	Case 1	Case 2	Case 3
1a: Case description
Type of perforation	Post-VATS for esophageal duplication cyst having post-op tear of day 5	Post-esophagectomy anastomotic leak referred here for further care	Boerhaave syndrome
Site of perforation	5 cm above the GE junction	Mid-esophagus	2 cm above GE junction
Age	30 years	58 years	53 years
Primary rent repair	Done	Done	Done
Type of feeds	TPN + FJ	TPN	TPN
Defect size	2.5 cm	3 cm	2 cm
1b: Case outcomes
Restoration of defect	Yes	No	Yes
Length of hospital stay	6 weeks	3 weeks	4 weeks
Number of dressing changes needed	7 sessions	4 sessions	3 sessions
ICD insertion	Yes	Yes	No
Vacuum device	3M	Capture Meditech	Capture Meditech

Publication History

Article published online:
22 April 2024