title: The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations.
abstract: Upper intestinal leaks and perforations are associated with high morbidity and mortality rates. Despite the growing experience using endoscopically placed stents, the treatment of these leaks and perforations remain a challenge. Endoluminal vacuum (E-Vac) therapy is a novel treatment that has been successfully used in Germany to treat upper gastrointestinal leaks and perforations. There currently are no reports on its use in the USA.
  
  
  
  E-Vac therapy was used to treat 11 patients with upper gastrointestinal leaks and perforations from September 2013 to September 2014. Five patients with leaks following sleeve gastrectomy were excluded from this study. A total of six patients were treated with E-Vac therapy; these included: (n = 2) iatrogenic esophageal perforations, (n = 1) iatrogenic esophageal and gastric perforations, (n = 1) iatrogenic gastric perforation, (n = 1) gastric staple line leak following a surgical repair of a traumatic gastric perforation, and (n = 1) esophageal perforation due to an invasive fungal infection. Four patients had failed an initial surgical repair prior to starting E-Vac therapy.
  
  
  
  All six patients (100 %) had complete closure of their perforation or leak after an average of 35.8 days of E-Vac therapy requiring 7.2 different E-Vac changes. No deaths occurred in the 30 days following E-Vac therapy. One patient died following complete closure of his perforation and transfer to an acute care facility due to an unrelated complication. There were no complications directly related to the use of E-Vac therapy. Only one patient had any symptoms of dysphagia. This patient had severe dysphagia from an esophagogastric anastomotic stricture prior to her iatrogenic perforations. Following E-Vac therapy, her dysphagia had actually improved and she could now tolerate a soft diet.
  
  
  
  E-Vac therapy is a promising new method in the treatment of upper gastrointestinal leaks and perforations. Current successes need to be validated through future prospective controlled studies.
authors.affiliation: Department of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, 1st Floor, Roberts Hospital, Dallas, TX, 75246, USA. Nathan.smallwood@baylorhealth.edu.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Smallwood
authors.affiliation: Department of Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, 1st Floor, Roberts Hospital, Dallas, TX, 75246, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.affiliation: Department of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, 1st Floor, Roberts Hospital, Dallas, TX, 75246, USA.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Leeds
authors.affiliation: Department of Gastroenterology, Baylor University Medical Center at Dallas, 3500 Gaston Ave, Wadley Tower Suite 556, Dallas, TX, 75246, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Burdick
mesh_terms: D057868:Anastomotic Leak / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004939:Esophageal Perforation / Q000628:therapy*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries / Q000601:surgery*; D013272:Stomach Diseases / Q000628:therapy*; D017792:Surgical Stapling; D014618:Vacuum
keywords: Endoscopy; Esophagus; Gastric; Leak; Perforation; Vacuum therapy