834 ENDOSCOPIC VACUUM THERAPY IN THE MANAGEMENT OF OESOPHAGEAL PERFORATIONS AND POST-OPERATIVE LEAKS

Abstract

Abstract Oesophageal perforations and post-oesophagectomy anastomotic leaks are associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a novel treatment strategy with the potential to promote healing and ameliorate sepsis. Few instances of the use of EVT have been reported in the UK, wioth only two cases published outside our centre representing a limited aetiological and demographic spectrum. Methods From May 2019 to November 2020 8 patients aged 27–85 years underwent EVT for disparate oesophageal wall defects. Data regarding technical success and feasibility were analysed. Video recordings of procedures were undertaken with patient consent. Results Complete defect resolution was achieved in cases (87%), requiring median of 13 days of treatment (range 6–23), and necessitating 3 replacement procedures (range 1–4). Significant improvement in C-reactive protein was achieved in all patients undergoing treatment (P = 0.015). Over an average follow up of 360 days, no severe complications resulted directly from sponge placement, however 2 individuals (25%) developed oesophageal stricture necessitating endoscopic balloon dilatation, and one died whilst undergoing treatment. Conclusion Here we provide a video demonstration of the application of EVT in patients with oesophageal perforation or post-operative leak. Our data demonstrate this approach to be a safe, valuable tool for the management of a spectrum of oesophageal wall defects, with the potential to reduce associated morbidity and mortality in selected patients. Video Video of safe application of EVT. https://www.dropbox.com/s/rgypt6o1z93iui5/EVT.mp4?dl=0.