Vacuum Therapy Research Articles

EGS SO24 - Endoscopic Vacuum Therapy for Oesophageal Perforation and Anastomotic Leaks

Abstract Background Oesophageal perforations and oesophago-gastric (OG) anastomotic leaks are challenging conditions, associated with significant morbidity and mortality. In recent years, endoscopic vacuum (EndoVac) therapy has emerged as a novel, alternative intervention for source control and to promote healing. Introduced to our unit in 2019, this cohort study presents our experience with EndoVac management of both post operative OG anastomotic leaks and primary oesophageal ruptures. Method Retrospective analysis of patient electronic records was conducted for all patients who received EndoVac management between the study period of October 2019 to June 2023. Pertinent outcome variables included length of vacuum therapy, number of changes, length of admission, in hospital and 90 day mortality rates. Results 37 patients were identified within the study period. The average age of this study cohort was 68 years with a mode ASA of III. The most common indication for EndoVac therapy was anastomotic leak (56%), followed by oesophageal perforation (31%). Defect resolution was achieved in 72% of patients. The median duration of treatment was 26 days (range 2-157), whilst the median number of changes was 7 (range 2-31). The overall in hospital complication (Clavien Dindo I-V) rate was 34%. The 90-day mortality rate was 22% whilst the morbidity rate was 13% in the form of anastomotic stricturing requiring serial dilatations. Conclusion EndoVac therapy is an effective minimally invasive treatment for post operative OG anastomotic leaks and oesophageal ruptures. With ongoing expansion in it’s use in our unit and throughout the UK, further work is required to assess the long-term outcomes and develop guidelines around its use in both oesophageal leaks and perorations.

EGS SO20 - Management & outcomes from oesophageal perforations at a tertiary centre

Abstract Background Oesophageal perforations, whilst rare, are a challenging surgical emergency. Traditionally associated with high morbidity and mortality, outcomes have progressively improved over the past 25 years, likely due to advances in medical care and specialised management in high volume tertiary centres. This study examines the management strategies and outcomes from oesophageal perforations at our tertiary unit. Method A retrospective cohort analysis was conducted on consecutive emergency cases of thoracic and junctional oesophageal perforations from January 2019 to June 2024. Data on patient demographics, baseline characteristics, management strategies and clinical outcomes were extracted from the patient’s electronic records. Kaplan-Meier survival curves were generated using the management approach and the extent of perforation as the predictive variables. Results 51 patients (mean age 47 years, 66% male) were treated for oesophageal perforations. The predominant aetiology was spontaneous (80%, n=41). Contained perforations were identified in 57% (n=29) of patients based on imaging, endoscopic, or operative findings. Conservative management was applied in 57% (n=29) of cases. Among those requiring intervention, 11 (58%) underwent surgery, while the remainder underwent endoscopical via vacuum therapy (32%, n=6) or stenting (11%, n=2). The mean in-hospital stay was 11 days (IQR 7-29). The 30-day mortality rate was 18% (n=9). Survival analysis revealed improved survival probabilities with contained perforations and non-surgical management strategies (p=0.023 and 0.001 respectively). Conclusion Our results demonstrate that the outcomes from oesophageal perforations continue to improve, reflecting ongoing advancements in therapeutic management. Furthermore, whilst surgery was once the mainstay, there appears to be a safe, increasing shift towards more conservative and endoscopic management.

AHP SO06 - A case report of the nutritional and multi-disciplinary team (MDT) management of an emergency oesophageal perforation associated with Eosinophilic Oesophagitis (EOE)

Abstract Background EOE once considered rare, is a chronic inflammatory condition of the oesophagus presenting as dysphagia and food impaction in children and adults. Awareness and management of EOE is variable despite an increasing prevalence and the condition deemed the most common cause of oesophageal perforation in adults and children by the British Society of Gastroenterology (BSG). This case review aims to increase the awareness of EOE, highlight the clinical presentation of EOE, discuss considerations for the nutritional management and the importance of an MDT approach to the care of this condition in relation to the BSG consensus guidelines. Method The patient was admitted to a specialist oesophago-gastric surgical centre in the Northwest of England. A retrospective review of the patient’s case notes was completed. This included exploration of all inpatient and outpatient contacts stored in the electronic patient records system. Results 18-year-old underweight male with IgE-mediated nut allergy and odynophagia, developed complex multi-site oesophageal perforations following OGD. Management included 40-day endoluminal vacuum therapy and extensive nutritional support. Although initial biopsies lacked diagnostic quality and conclusive results, EOE was subsequently confirmed. Dietetic evaluation included nutritional status, atopic history, symptoms, and dietary intolerances. MDT discussions influenced care continuity and patient compliance. Feeding delays attributable to frequent theatre visits impacted continued weight loss; addressed with allergen-free enteral and parenteral feeding, and dietary reintroduction, following six-food elimination once perforations had healed. Healthy BMI was achieved through patient’s preferred long-term management of normal diet and Budesonide. Conclusion Increased awareness of EOE is paramount for patients presenting with unexplained oesophageal perforation. Obtaining biopsy samples as per BSG guidance supports earlier diagnosis and management plan. A thorough clinical history including childhood eating behaviours, atopic history, dietary intolerances and symptom presentation from the patient and relatives gathers collateral information to support diagnosis and treatment planning. Joint discussions regarding pharmaceutical management, dietary elimination and reintroduction are important to achieve remission. The case highlights the importance of collaborative MDT working with the surgical, medical and dietetics whilst empowering the patient to make informed decisions regarding the nutritional and medical management of condition.

OGC SO40 - Oesophageal Stents with fixation device for anastomotic leaks after oesophagectomy: Our initial experience

Abstract Background Anastomotic leaks following oesophagectomy are associated with significant morbidity and mortality. The management of these leaks also presents significant clinical and nutritional challenges. The role of endoscopic interventions such as endoluminal vacuum therapy and endoscopic stents in management of these leaks has increased over the past decade. We present our experience in the use of endoscopic stents with a stent fixation device over the last 4 years. Method Detailed patient records were retrospectively reviewed to assess the indications, procedural success, complications and overall clinical outcomes for patients with anastomotic leaks following Ivor-Lewis oesophago-gastrectomy (ILO) at our institution from January 2021 to June 2024 treated endoscopically with fully-covered self-expanding metal stents using stent fixation devices. Results 5 patients had post-ILO anastomotic leaks treated with endoscopic stents. The stents were fixed to the proximal oesophagus using a stent fixation device (Stentfix clip). 1of the 5 patients continued to leak despite the stent, leading to prolonged recovery. The remaining 4 achieved leak resolution after stent insertion without needing further intervention. No stent-related procedural complications were noted. The patients progressed on to oral diet/nasogastric feeding within a median of 8 days (Range: 1-18). The median hospital stay following stenting was 29 days (range 7-39). The stents remained in situ for 3 months and were succcesfully removed endoscopically thereafter. Conclusion Endoscopic stenting with a fully covered stent and a stent fixation device (alongside pleural drainage) is a highly effective and safe intervention for managing anastomotic leaks after ILO. It does not entail multiple procedure and oral feeding can be commenced relative quickly. It potentially minimizing the need for more complex procedures and reduces overall hospital stay and costs in the management of anaestomotic leaks.

EGS SO29 - Therapeutic Endoluminal Vacuum Therapy (EVT) as first line management for oesophageal and selected gastric and duodenal perforations

Abstract Background Upper gastro-intestinal (GI) perforations and leaks affect roughly 2,800 patients annually in the UK. They can occur spontaneously, as a complication of medical intervention, or be due to trauma. Mortality rates are around 20%, rising to 50% if diagnosis and treatment is delayed. Around a third of cases fall into the delayed category. Traditionally, management of this group of patients involved surgery with long hospital stays and poor outcomes. Our Unit has adopted EVT as first line management for these cases, using an ad-hoc Endoluminal Vacuum Device (EVD), which has significantly improved patient outcomes compared to traditional treatment strategies. Method The primary aim of this study was to assess the successful perforation/ leak healing rate, the overall mortality rate, and the complication rate of EVT. A retrospective analysis of a prospectively collated database for all patients who received EVT between May 2011 to November 2023 was performed. Patients who had oesophageal, gastric or duodenal perforations were included. The ad-hoc EVD was constructed using an open pore sponge (granufoam, KCI) sutured to the end of a nasogastric (NG) tube. This was inserted endoscopically into the site of perforation and with negative pressure (125mmHg) applied using a negative pressure vacuum pump. Results 104 patients received EVT, with a median age of 65years (range 23-92years), and median ASA of 3 (range 1-5) at presentation. Eighty-five cases were oesophageal, 15 gastric and 4 duodenal. Post-operative leaks accounted for 42 cases, 26 were iatrogenic, 30 spontaneous, and 6 traumatic. Leak resolution was achieved in 94 patients (90.4%). Twelve (11.5%) patients died; 7 (6.7%) deaths were due to treatment failure. Seven (6.7%) patients had a significant bleeding event during EVT of which 4 (3.8%) were directly related to the leak because of undrained sepsis. One patient had an oesophageal mucosal injury during EVD removal. Conclusion EVT is a safe and effective treatment for upper GI tract leaks regardless of their cause. It achieves a significant reduction in mortality compared to traditional treatments, especially in patients with delayed presentation. Adequate drainage of surrounding sepsis is essential to ensure therapy success and avoid bleeding complications. Given the improvement in patient outcomes that EVT delivers, it should be considered for first line management in patients with delayed diagnosis and presentation of oesophageal perforation, following anastomotic leak after resectional surgery, as well as in select patients with gastric and duodenal perforations.

EGS SO32 - Management of Spontaneous Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Spontaneous Oesophageal Perforation (SOP) is a rare gastro-intestinal surgical emergency with devastating morbidity and mortality. Given the rarity of the entity, there is no up-to-date evidence on outcomes in the context of centralized esophagogastric services neither consensus guidelines nor standardized treatment algorithms on how these should be optimally managed. Endoscopic Vacuum Therapy (EVT) has emerged as safe and effective option particularly in cases where major invasive surgery would otherwise be deferred. Herein, we sought to explore the effectiveness, patient benefit and related morbidity/mortality by exploring the strategy outcomes in SOPs prior to and during periods where EVT was available. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=72) presented or transferred to our tertiary oesophagogastric unit for SOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or perforation secondary to malignancy, iatrogenic, traumatic or food bolus were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day, 1-year mortality. Results In 2009-2017 pre-EVT period, 25/72 patients were managed a) 18/25 surgically with thoracotomy and T-tube, b) non-surgical 7/25, four were palliated. 30-day, 90-day mortality were 4/25 and 2/25, 90-day morbidity Clavien-Dindo >IIIa 14/25 (56%), 90-day reintervention 8/25 (32%), median LOS 27 days. In 2018-2023 EVT period , 47/72 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 18/47, b) non-surgical 15/47, c) endoscopy 6/47, d) EVT in 14/47. 30-day mortality was 6/47, 90-day mortality 2/47, 90-day morbidity Clavien-Dindo >IIIa 32/47 (68%), 90-day reintervention 26/47 (55.3%), median LOS 34 days. 1-year mortality was 5/25 and 3/47 respectively. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of spontaneous oesophageal perforations. Optimal patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is recommended as soon as such a diagnosis is confirmed.

EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality. Results In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo >IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo >IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.

OGC SO14 - Management of Anastomotic Leaks after oesophagectomy for oesophageal cancer in the era of Endoscopic Vacuum Therapy

Abstract Background Anastomotic leak (AL) is a serious complication following oesophagectomy that occurs in 10-15% of patients. Endoscopic vacuum therapy (EVT) is a novel non-operative approach to managing AL that has become increasingly popular recently. However, little is known about EVT’s effectiveness in managing ALs compared to more established approaches. Method This was a retrospective review of consecutive AL management in a regional oesophageal cancer centre during two distinct time periods: prior to (group 1, 2014-2018) and following (group 2, 2018-2023) the introduction of EVT. 66 patients met the inclusion criteria. Patients were further classified according to size and type of leak, degree of mediastinal soiling and degree of sepsis. Primary endpoints were treatment success, 90-day mortality, and long-term preservation of gastrointestinal continuity. Secondary endpoints were the length of hospital stay (LOS) and re-interventions during the first postoperative year. Results 80.3% of patients (14 in group 1, 40 in group 2) had less than 1cm AL defect with present sepsis and a small mediastinal cavity. In group 1, 12 were treated successfully conservatively, and 2 (14.2%) had T-tube insertion. In group 2, 20 (50%) had conservative management and 19 (47.5%) had Esosponge insertion. The success rate was 95% and 94.7%, respectively. In bigger ALs (>1cm defect with severe sepsis), all patients in group I were treated with thoracotomy with a success rate of 75%, whereas in group 2, 60% were treated with Esosponge insertion with a success rate of 83.3%. Conclusion EVT is a safe and feasible therapy option. It appears to improve outcomes in septic patients with small ALs and potentially reduces the need for high-risk revisional operations.

Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review.

Endoscopic vacuum therapy (EVT) has emerged as a transformative approach for managing gastrointestinal (GI) transmural defects, offering a less invasive and more promising alternative to surgery. Initially developed to address anastomotic leaks after rectal surgery, the application of EVT has expanded to include other locations within the GI tract. This review investigated the principles, indications, procedures, outcomes, challenges, and future perspectives of EVT for the management of GI transmural defects. In conclusion, EVT has demonstrated favorable outcomes in GI defect closure, with reduced complications, shortened hospital stay, and decreased morbidity rates as compared with conventional treatments. Although EVT faces challenges in some specific anatomical locations and in managing severe complications such as major bleeding, ongoing advancements in technology and standardization efforts offer promise for broader indications and better outcomes. Future perspectives include exploring novel EVT devices, refining patient selection criteria and pre-emptive applications, and standardizing procedural protocols.

Anastomotic leakage following surgical resection in the upper gastrointestinal tract

Surgical resection is the consistent component of curative treatment strategies for primary malignant diseases of the stomach and the esophagus. The placement of anastomoses for the necessary reconstruction still accounts for substantial morbidity and in the case of afailure to rescue also for mortality, especially for esophagojejunostomy and esophagogastrostomy. The diagnostics of anastomotic leakage routinely involve computed tomography and endoscopy and timely performance appears to be essential. Endoscopy can simultaneously initiate the essential treatment step. Amajor reason for the improvement of postoperative outcomes after resection in the upper gastrointestinal tract in the last decades is the successful and mostly endoscopically performed management of anastomotic leakage, whereby different endoscopic treatment options are now available. Endoscopic vacuum therapy has become established as the standard, normally with an endoscopic vacuum sponge technique but is also now supplemented by acombination system of vacuum sponge and stent. Furthermore, afoil-coated multiple lumen nasogastric tube represents another available option, which can possibly especially be used as aprophylactic measure. The longest established endoscopic therapy option for anastomotic leaks, the endoluminal metal stent, has been replaced as the standard by the vacuum treatment but is still used in suitable situations. Additionally, there are endoscopic suture devices that are currently only used very occasionally. Surgical revision is always available as treatment escalation but is only recommended for very early occurrences and possibly technically related anastomotic leakage and in the case of failure of endoscopic treatment. This article describes and summarizes the diagnostics and treatment of anastomotic leakages after surgical procedures of the upper gastrointestinal tract.

Review for the monograph "Vacuum Therapy in Surgery": a textbook for military doctors and doctors of the health care system of Ukraine / S. Aslanian, V. Bilyi, Y. Zarutskyi, S. Korol, A. Laksha, I. Sobko – Kyiv, 2023. 247 p.

Review for the monograph "Vacuum Therapy in Surgery": a textbook for military doctors and doctors of the health care system of Ukraine / S. Aslanian, V. Bilyi, Y. Zarutskyi, S. Korol, A. Laksha, I. Sobko – Kyiv, 2023. 247 p.

Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis.

Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a metanalysis of the available data on the clinical success rate of EVAC. Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

S3193 Drowning in Food? Management of an Esophagojejunal Anastomotic Dehiscence through Endoluminal Vacuum Therapy

S3193 Drowning in Food? Management of an Esophagojejunal Anastomotic Dehiscence through Endoluminal Vacuum Therapy

S4057 Endoscopic Vacuum Therapy for the Management of Atrial Fibrillation-Induced Esophageal Perforation

S4057 Endoscopic Vacuum Therapy for the Management of Atrial Fibrillation-Induced Esophageal Perforation

Endoscopic vacuum therapy for treatment of large distal anastomotic dehiscence after colorectal surgery

Background: Management of anastomotic dehiscences following colorectal surgery is a topic of debate. In this context, endoluminal vacuum therapy offers promising results. Objective: To analyze the efficacy and feasibility of endoluminal vacuum therapy in distal anastomotic dehiscences after colorectal surgery. Materials and methods: This study is a descriptive case series that evaluates patients with anastomotic dehiscences over a period of 18 months. All patients were treated with Endo-sponge™ (Braun Medical, Hessen, Germany). Results: Fourteen patients were included in the final analysis. The indications for endoluminal vacuum therapy were Hartmann's stump insufficency (n=6), anastomotic leakage after laparoscopic total mesorectal excision (n=4), and anastomotic dehiscence after transanal total mesorectal excision (n=4). A total of 204 sponges were placed per patient (median 12.5, range 1-33). Complete resolution was achieved in 9 patients (57.1%) in a mean time of 108 days (range 15-160 days). In the sub-analysis, patients with acute dehiscence (<3 months) achieved complete resolution in 80% (8/10), whereas no patient with chronic defects reached resolution (0/4). A low complication rate (7%) was recorded. Conclusion: Endoluminal vacuum therapy appears to be a feasible and safe treatment with a high success rate in patients with large acute colorectal anastomotic defects.

Nonoperative Management Strategies for Anastomotic Leaks After One Anastomosis Gastric Bypass (OAGB): A Literature Review.

One Anastomosis Gastric Bypass (OAGB) has gained widespread acceptance as an effective bariatric surgery due to its relative simplicity and favorable outcomes in weight loss and metabolic improvement. However, anastomotic leaks, though uncommon, present a significant complication with the potential for severe morbidity and mortality if not managed appropriately. This review examines the range of nonoperative strategies currently employed to manage anastomotic leaks and fistulae following OAGB. The focus is on endoscopic techniques, including the use of clips, stents, suturing systems, internal drainage, vacuum therapy, and tissue sealants, which have been successfully used in various gastrointestinal surgeries. Although a proportion of patients will require surgical treatments, these strategies offer less invasive alternatives to surgical intervention and can be tailored to the specific characteristics of the leak and patient condition. However, the application of these techniques specifically for OAGB-related leaks is not as well-documented. This review lists the available evidence on these nonoperative approaches, highlighting some of their potential benefits and limitations. While these methods show promise, there is a clear need for further research to establish standardized protocols and optimize their use in the context of OAGB-related leaks and fistulae.

Ileoanal pouch salvage rates with endoluminal vacuum therapy for early vs late anastomotic leaks

BackgroundAnastomotic leaks after ileal pouch-anal anastomosis (IPAA) significantly compromise patient outcomes and increase healthcare resource utilization. The aim of this study was to evaluate the outcomes of endoluminal vacuum therapy (EndoVac) for pouch leaks. We hypothesized that EndoVac for early compared with late leaks was associated with a higher pouch survival rate. MethodsWe retrospectively reviewed consecutive pouch anastomotic leaks treated with EndoVac therapy at our institution between 2013 and 2023. Patients were stratified into early (≤30 days) and late (>30 days) leak groups. Anastomotic healing was defined as complete closure of the leak site and resolution of symptoms. Pouch failure was defined as a permanent ileostomy or pouch excision. The probability of pouch survival was estimated using the Kaplan-Meier method. ResultsA total of 14 patients with IPAA were included: median age, 34 years; 71% were males; and median body mass index, 23.46 kg/m2. The following were the diagnoses made: ulcerative colitis (n = 12) and familial adenomatous polyposis (n = 2). The median (IQR) time from pouch construction to leak was 44.5 (12−192) days; of these, 6 (43%) were early, and 8 (57%) were late. All (100%) leaks were at the anastomosis; all (100%) were diverted at the time of EndoVac therapy: 10 (71%) still diverted, and 4 (29%) rediverted. Patients underwent a median of 5.5 EndoVac changes (3−7) over a 13.5 (6−21) day period from initiation of treatment to cessation of therapy. After EndoVac therapy, healing was observed in 10 (71%) patients; 2 of whom required a minor handsewn anastomotic revision but healed completely, and 4 did not heal; 3 had pouch excision, and 1 underwent redo pouch surgery. Anastomotic healing (66.7% vs 75%, P = .7) and pouch survival (83.3% vs 75%, P = .73) were not significantly different between the early and late leak groups. The overall pouch salvage rate was 78.5%. ConclusionEndoVac therapy was effective in achieving high rates of pouch salvage and anastomotic healing in patients with ileoanal pouch leaks, irrespective of the timing of intervention postoperatively. This supports the use of EndoVac as a viable treatment option for both early and late anastomotic leaks.

ThP3.3 - Prophylactic Endoluminal Vacuum Therapy – towards an era of reducing leak related morbidity after elective oesophago-gastric resection

Abstract Aims Uncontrolled sepsis following leak from oesophago-gastric surgery is a devastating condition with increased morbidity & mortality affecting longer-term cancer-free survival in patients with cancer resections. We hypothesised that endoluminal vacuum therapy (EVT), previously used to treat leaks, could be used in prophylactic settings to provide source-control, prevent mediastinitis and minimise sepsis related morbidity from leaks. Methods An ad-hocEVT device was created using VACgranufoam (KCI)and a nasogastric-tube(16/18Fr), and placed intraluminally across the repair/anastomosis in select high-risk cases. Continuous negative pressure(75–125mmHg) was applied. Assessment of the repair-site/anastomosis was performed by radiology, endoscopy, clinical assessment or a combination following cessation of EVT. Results 27 patients had prophylactic EVT; M:F ratio was 3:1 and the median age was 68 years (range: 41-82years). 26surgeries were for cancer, while 1 was benign. The rationale for prophylactic EVT included patient related (10), technical factors (16) or both (1). The median duration of prophylactic EVT was 7 days (range: 4-14days). The median length-of-stay was 19.7 days (range: 6-96 days), the two longest admissions were unrelated to the anastomosis(prolonged chyle-leak, and long-term-sequelae of life-threatening bleed). One-patient developed a full-thickness microleak at endoscopic-evaluation, yet remained well with no systemic signs of sepsis, successfully managed with luminalEVT for a further 6days in a ward-based environment. Though prophylacticEVT did not prevent the leak, it significantly minimised the systemic hit that traditionally results from leak and associated mediastinal sepsis. Conclusions ProphylacticEVT is a useful adjunct for management of patients with a high risk for leak, though not a substitute for good surgical technique. There are no short-term complications, yet the additional morbidity, mortality and length-of-stay associated with a fully-fledged leak is avoided. Randomised-controlled-trials are required to further standardise selection criteria, assess potential patient benefit and longer-term impact on survivorship.

770. CLOSURE OF OESOPHAGEAL DEFECTS USING THE VACSTENT DEVICE: INITIAL INSIGHTS FROM THE LARGEST UK CASE SERIES

Abstract Introduction Oesophageal defects are associated with poor morbidity and mortality and often require prolonged hospitalisation and artificial nutrition. Existing endoscopic treatment modalities exhibit limitations. Covered stents are associated with a migration rate of up to 50% and closure with endoscopic clips is limited to simple defects. Vacuum therapy is a well understood and established surgical therapy to promote wound healing. Endoscopic Vacuum Therapy (EVT) utilises these principles in the management of transmural oesophageal defects. The VACstent GITM (MicroTech) is a novel device which synergistically incorporates the advantages of a fully covered oesophageal stent while concurrently employing EVT. This approach seals the defect while mitigating against stent migration through the vacuum effect. Luminal patency is also maintained which helps to preserve nutritional independence. Accelerated healing and enhanced nutrition are thought to help reduce morbidity and enhance patient quality of life. Methods This single-centre prospective case series describes outcomes for patients with transmural oesophageal defects treated with the VACstent GITM device. All procedures were performed with propofol sedation and fluoroscopic guidance. The VACstent GITM was exchanged every 5-7 days until endoscopic closure. A contrast study was used to confirm closure after which oral nutrition was restarted. The primary outcome was clinical success, defined as the endoscopic and radiological evidence of defect closure. Secondary outcomes included number of stent exchanges, technical success, and the adverse event (AE) rate. Results The VACstent GITM device was used for seven patients between October 2023 and February 2024. Four patients had anastomotic leaks with three having iatrogenic perforations. The mean patient age was 60 (± 19.3) years with 57% of the patient cohort being male. The clinical success rate was 86% with a technical success rate of 100% and a median defect closure time of 13 (± 6.6) days. A median number of 1 stent exchanges was required. The median defect size was 8mm (± 6.2). There were no reported AEs. All patients were able to successfully come of artificial nutrition. Conclusion This case series illustrates the safety and efficacy of the VACstent for the treatment of a heterogenous group of oesophageal defects. To our knowledge this represents the largest series in a cohort of patients from the United Kingdom. Larger scale comparative studies incorporating a more diverse patient cohort will further clarify the potential of the VACstent device in reducing the necessity for major surgical interventions in this complex and challenging patient population. It will also help to refine future treatment algorithms for oesophageal defect management.

304. OUTCOMES OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY BEFORE AND AFTER IMPLEMENTATION OF ENDOSCOPIC VACUUM THERAPY IN A TERTIARY REFERRAL CENTER

Abstract Background Anastomotic leakage (AL) after esophagectomy is associated with severe morbidity and a high mortality. Endoscopic vacuum therapy (EVT) has recently been established as a promising endoscopic treatment option for AL, with success rates of higher than 80%. The aim of this study was to compare outcomes of AL after esophagectomy, before and after implementation of EVT. Methods For this cohort study, consecutive patients with AL after transthoracic esophagectomy with gastric conduit reconstruction with cervical or thoracic anastomosis from two different time periods (before the implementation phase of EVT [2013–2017, pre-EVT], and after [2020–2023, EVT]) were included. Data was collected from a prospectively maintained database. Outcome measures included initial treatment modality, re-operation, intensive care unit (ICU) admission, hospital stay, and complications, classified according to Clavien-Dindo. Results 100 patients with AL were included, with 50 patients in the pre-EVT group and 50 patients in the EVT group. In the pre-EVT group, initial treatment of AL consisted of conservative therapy (n=20, 40%), endoscopic stenting (n=13, 26%), endoscopic drainage (n=6, 12%) or surgery (n=11, 22%). In the EVT group, initial treatment of AL consisted of conservative therapy (n=5, 10%), surgery (n=2, 4%) or EVT (n=43, 86%). Other baseline characteristics showed no differences. The EVT group had a significantly lower initial surgical treatment rate compared to the pre-EVT group (respectively 2 [4%] vs. 11 [22%], p=0.03). Furthermore, the EVT group had a significantly lower ICU admission rate than the pre-EVT group (respectively 16 [32%] vs. 35 [70%], p<0.001). Clavien-Dindo classification differed significantly between the two groups (p = 0.033), with less Grade IIIa and more Grade IVa in the pre-EVT group, compared to the EVT group. Reoperations occurred in 17 patients (34%) in the pre-EVT group and 9 (18%) in the EVT group, which was not statistically significant. No statistically significant difference was observed in length of hospital stay. Conclusion The implementation of EVT as treatment option for AL after esophagectomy in this tertiary referral center may have led to a lower ICU admission rate. Taking this into consideration, EVT may be associated with long term health benefits for the patient and reduced healthcare costs.