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Abstract

We thank Sánchez-Luna et al1Sánchez-Luna S.A. Thompson C.C. Guimarães Hourneaux De Moura E. Modified endoscopic vacuum therapy: Are we ready for prime time?.Gastrointest Endosc. 2022; 95: 1281-1282Abstract Full Text Full Text PDF Scopus (1) Google Scholar for their interest in our recent publication about endoscopic vacuum therapy (EVT) for the management of upper GI (UGI) leaks and perforations.2Jung D.H. Huh C.W. Min Y.W. et al.Endoscopic vacuum therapy for the management of upper GI leaks and perforations: a multicenter retrospective study of factors associated with treatment failure (with video).Gastrointest Endosc. 2022; 95: 281-290Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar UGI leaks and perforations lead to serious conditions associated with high morbidity and mortality. A recent meta-analysis showed that EVT for the treatment of UGI leaks and perforations is effective.3Jung D.H. Yun H.R. Lee S.J. et al.Endoscopic vacuum therapy in patients with transmural defects of the upper gastrointestinal tract: a systematic review with meta-analysis.J Clin Med. 2021; 10: 2346Crossref PubMed Scopus (6) Google Scholar Sánchez-Luna et al1Sánchez-Luna S.A. Thompson C.C. Guimarães Hourneaux De Moura E. Modified endoscopic vacuum therapy: Are we ready for prime time?.Gastrointest Endosc. 2022; 95: 1281-1282Abstract Full Text Full Text PDF Scopus (1) Google Scholar have introduced a cost-effective modified EVT that compensates for the shortcomings of the current EVT.4de Moura D.T.H. do Monte Junior E.S. Hathorn K.E. et al.Modified endoscopic vacuum therapy in the management of a duodenal transmural defect.Endoscopy. 2021; 53: E17-E18Crossref PubMed Scopus (6) Google Scholar,5de Moura DTH, Hirsch BS, Boghossian MB, et al. Low-cost modified endoscopic vacuum therapy using a triple-lumen tube allows nutrition and drainage for treatment of an early post-bariatric surgery leak. Endoscopy. Epub 2021 Aug 9.Google Scholar As the authors stated, the efficacy of modified EVT is promising. We agree with the authors that the traditional polyurethane sponge is associated with challenging placement and removal, is a time-consuming and technically demanding procedure, and needs multiple exchanges resulting from tissue ingrowth. In our study, the intraluminal method was also significantly associated with EVT failure. We think that more effective drainage and precise positioning of the sponge can be achieved with the intracavitary method. In other words, a polyurethane sponge can be applied to an intracavitary lesion when it is technically easy to insert a sponge into the cavity. Therefore, if the opening of the fistula has an acute angulation that is considered unsuitable for insertion of a sponge into the fistula, we perform the intraluminal method of EVT. From this point of view, modified EVT has a small caliber and can be more easily placed in either an intracavitary or an intraluminal manner.4de Moura D.T.H. do Monte Junior E.S. Hathorn K.E. et al.Modified endoscopic vacuum therapy in the management of a duodenal transmural defect.Endoscopy. 2021; 53: E17-E18Crossref PubMed Scopus (6) Google Scholar,6de Moura D.T.H. Hirsch B.S. Do Monte Junior E.S. et al.Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages.VideoGIE. 2021; 6: 523-528Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Additionally, the use of a triple-lumen catheter allows for nutrition. Therefore, it is feasible and appears to be as safe and effective as the traditional sponge EVT system. We hope that additional studies with a larger number of patients can be published in the near future. Modified endoscopic vacuum therapy: Are we ready for prime time?Gastrointestinal EndoscopyVol. 95Issue 6PreviewWe 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. Full-Text PDF