Vacuum Therapy Research Articles

Use of Vacuum in The Treatment of Acute Lung Abscess in Patients with Diabetes

Abstract of acute lung diseases. This problem is of particular importance when considering the growth of patients with diabetes. It should be noted that the emergence of antibiotics is a result of not using antibacterial drugs. Since the implementation. According to various authors, the number of complications in patients remains high, regardless of the rapid development of modern technologies used in the treatment of modern technologies requires the purchase of expensive specialized costs, the economic sector of the lung is also important for diabetes. In the background of appropriate surgical methods, use vacuum therapy in the treatment of acute diabetes and help early decontamination and cleaning of fibrin tissue and fibrin, accelerate the last necrotic tissue and fibrin This allows us to reduce the time of patients

Refractory esophageal–mediastinal fistula successfully treated with endoluminal vacuum therapy and enteral nutrition using a double-lumen elemental diet tube: a case report

BackgroundAortic–esophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) has a high fatality rate and is difficult to treat. Endoluminal vacuum therapy (EVT) has recently appeared and proven to be a useful method for anastomotic leakage.Case presentationA 76-year-old man underwent aortic arch replacement for a stent graft infection after TEVAR. Persistent mediastinitis and pyothorax were observed after aortic arch replacement, and further examination revealed an esophageal–mediastinal fistula (EMF). Over-the-scope clip (OTSC®) closure was performed to treat EMF but achieved no cure. Then, the patient was referred to our hospital. First, we removed the OTSC® that interfered with the treatment using the remOVE System® and started EVT using a double-lumen elemental diet tube (W–EDT®). The vacuum sponge was affixed to the vacuum side of W–EDT®, and enteral nutrition administered through W–EDT was combined with EVT. EMF was cured 11 days after EVT, and the patient was able to feed himself.ConclusionThe combination of EVT and enteral nutrition feeding using W–EDT® is a successful novel procedure to treat refractory EMF.

EGS P17 Expanding the technical armamentarium to treat complex oesophageal perforations with Endoluminal Vacuum Therapy

Abstract Background Endoluminal vacuum therapy (EVT) is increasingly the default treatment modality for oesophageal leaks. If the leak cavity is large or has a dependent element, placement of the endoluminal vacuum device within the leak cavity facilitates healing. However, accessing the leak cavity can be challenging when the oesophageal defect communicating with the leak cavity is small, and it is tempting to default to luminal EVT. This can lead to a EVT failure. We present a case where luminal EVT in the presence of an established leak cavity with a narrow inlet resulted in stagnation of therapy requiring an alternative technical approach. Methods An 80-year-old high-risk female with Boerhaave's syndrome presented with a 4cm esophageal defect and a large mediastinal leak cavity. An ad-hoc endovacuum therapy (EVT) device, consisting of V.A.C granufoam (KCI) attached to a 14Fr nasogastric (NG) tube, was placed in the leak cavity at -125mmHg pressure. The EVT device was replaced every 3-8 days. After 101 days, luminal EVT was adopted due to cavity narrowing. Partial closure of the esophageal defect was achieved, but a persistent mediastinal abscess communicated through a residual pinhole defect. Additional luminal EVT and image-guided drainage couldn't resolve the persistent esophageal fistula, confirmed by contrast-enhanced CT. Results Endoluminal access to the leak cavity was re-established by dilating the fistula using a TTS 12mm radial expansion wire-guided balloon catheter enabling re-establishment of intra-cavity EVT. Having regained access, further intra-cavity EVT using an ad-hoc EVT device fashioned from black granufoam (KCI) sutured to a 10Fr or 12Fr ng tube with 125mmHg negative pressure was applied. The EVT device was changed every 3-6 days. After further 25 days of EVT complete healing was observed. Conclusions Whilst intraluminal EVT has a role in oesophageal leaks associated with small leak cavities which have no dependent element, larger leak cavities require intra-cavity EVT. If access to the leak cavity is challenging due to the small size of the oesophageal defect, endoscopic measures to facilitate endoluminal access to the leak cavity such as dilation of the defect can be safely employed to enable delivery of intra-cavity EVT. This should be considered when endoluminal access to the leak cavity is prevented due to the small size of the defect obviating the need for other more invasive interventions such as surgery.

EGS P02 Lessons learnt from 450 Endoluminal vacuum therapy (EVT) procedures in the treatment of upper gastrointestinal perforations and leaks

Abstract Background Endoluminal vacuum therapy (EVT[BA1] ) is a novel, yet relatively well established tool in the management of upper gastrointestinal (UGI) leaks and perforations. Despite a growing body of evidence supporting its use, management strategies and techniques used in the context of EVT are yet to be standardised. Furthermore, the uptake of EVT in the UK is limited to a small number of centres. This project aimed to summarise the key lessons learnt from our initial experience of 450 EVT procedures, to inform others about how this technique can be integrated into regular clinical practice. Methods This study draws on experiential reflections and analysis of a prospective database of 450 EVT procedures in 59 patients in our unit from October 2018 – June 2023. This included patients who had undergone oesophago-gastric (OG) cancer resections, bariatric surgery (index procedures both in the UK and abroad) and those presenting with benign disease (oesophageal perforation and iatrogenic injury). The setting was a regional tertiary OG and bariatric centre in the North West of England serving a cancer and benign population of 3.5 million people and a larger undetermined population for bariatric emergencies. Results 51/59 (86%) patients were successfully managed with 446 EVT procedures. Patient, system and technical factors were identified which when addressed, facilitated expeditious healing of leaks, and enabled active management patients unfit for more invasive interventions. Factors included understanding the indications for using and stopping EVT, control of sepsis, and optimisation of nutrition and glycaemic control. Technical factors included sponge placement, managing foreign material (e.g. redundant sutures and drains) and approaches to managing necrosis. System factors included supporting a training programme, the necessity of a comprehensive team approach and the financial and governance challenges with adopting a novel intervention. Conclusions EVT is as an effective technique in the management of complex UGI leaks and perforations. There are multiple patient, financial, logistical, governance and systems factors that present as challenges to the implementation of this technique into routine practice. An integrated team-based approach is key to adoption of EVT by other centres into their routine practice.

EGS P03 Outcomes from 450 Endoluminal Vacuum Therapy (EVT) Procedures in the Management of Upper Gastrointestinal Leaks and Perforations

Abstract Background Anastomotic leaks and perforations of the upper gastrointestinal (UGI) tract are life-threatening conditions which result in significant rates of morbidity. There is no consensus with respect to how these challenging cases should be optimally managed. Endoluminal vacuum therapy (EVT) is a novel approach for the management of leaks and perforations in the UGI tract. Proponents highlight the benefits of its use particularly in cases where major invasive surgery or re-operation would otherwise usually be required. We present the outcomes from nearly 450 EVT related procedures during the last 5 years. Methods A retrospective analysis of all UGI leaks and perforations managed with EVT between September 2018 and June 2023 was undertaken. This included patients who had undergone cancer resections (oesophagectomy and gastrectomy), bariatric surgery (both within and out with our centre) and those presenting with benign disease (e.g. oesophageal perforation and iatrogenic injury). The setting was a regional tertiary oesophago-gastric and bariatric centre in the North-West of England serving a population of over 3.5 million people. Demographic data, patient and disease factors, nutrition-related data, and outcomes related to EVT were collected. Descriptive and statistical analysis was undertaken. Results 59 patients (43 males; median age 61) underwent 446 EVT related procedures during the study period, of which 52 (88%) were alive at discharge. Median LOS was 43 days. 66% (39/59) cases related to post-operative leak (resection 28, bariatric surgery 11) vs 11/59 spontaneous and 8/59 iatrogenic perforations. Median number of procedures was 6 (IQR 3-11) over a median of 21 days (IQR 11-41). Successful healing was achieved in 86% (51/59) cases. There was no difference in success rate between pathologies (p=0.88), however, iatrogenic perforations required fewer EVT procedures before healing (p=0.00). No adverse events were directly attributable to EVT. Conclusions UGI leaks and perforations represent a heterogeneous group which pose a significant management challenge. Our study suggests that EVT is a safe and effective approach in managing a broad range of different UGI leaks and perforations. EVT opens the possibility of active treatment for patients unsuitable for more invasive surgical intervention. Further study is required to standardise nomenclature, indications and follow-up. Comparisons to other management approaches are required to further explore the benefits for patients, taking into consideration clinical efficacy, impacts on quality of life and cost-effectiveness.

AHP P03 Challenges in the nutritional management of patients undergoing Endoluminal Vacuum therapy (EVT) for upper gastrointestinal (UGI) leaks and perforations

Abstract Background The management of upper gastrointestinal (UGI) leaks and perforations is complex and challenging. Patients often have multiple comorbidities, have undergone major surgical interventions with protracted pathways, and are associated with compromised nutritional states. Endoluminal Vacuum therapy (EVT) is a novel approach to managing UGI leaks that aims to avoid unnecessary major surgical intervention. Optimising nutrition for this cohort is of paramount importance, however, this may be challenging to achieve due to repeated interventions and interruptions in nutritional support. This study aimed to objectively measure and describe some of these challenges and explore areas of development to optimise outcomes for patients. Methods A retrospective analysis of all leaks and perforations managed with EVT between September 2018 and June 2023 was undertaken. This included patients who had undergone cancer resections (oesophagectomy and gastrectomy), bariatric surgery and those presenting with benign disease (e.g. oesophageal perforation and iatrogenic injury). The setting was a regional tertiary oesophago-gastric and bariatric centre in the North-West of England serving a population of 3.5 million people. A comprehensive dataset relating to the nutritional status of patients preoperatively and the change in nutritional parameters was collected and analysed. Results 59 patients (43 males; median age 61) were included; 88% were discharged from hospital. Median weight on admission and last EVT was 88.5kg (IQR 51-131kg) and 76.9kg. 31% had >10% pre-admission weight loss (IQR 2.4-30%). Median weight loss to last EVT was 7.1% (IQR +16.5 to -18.1%) vs. 9.4% (IQR +2 to -23%) for overall stay. Initial feeding routes were 46% (27/59) jejunostomy, 41% (24/59) parenteral nutrition (PN), 12% (7/59) PN/jejunostomy, and 2% (1/59) naso-gastric. Median weight loss during admission was less (9%) in the jejunostomy cohort versus the other feeding groups (PN 12.4%, PN/jejunostomy 13.9%, nasogastric 9.2%). Conclusions Meeting the nutritional needs in this complex, co-morbid and often nutritionally deplete group is a challenging task. Management algorithms were heterogenous and lacked consistency. An accurate understanding of nutritional requirements was difficult due to a combination of a lack of clinically validated guidelines and little consensus regarding which data points should be used to measure nutritional provision. These issues must be addressed to accurately ascertain the role of nutritional optimisation in this cohort, and to be able to identify modifiable factors and areas of development that may improve patient outcomes.

Local negative pressure technique in abdominal surgery: advantages, disadvantages, controversial issues

A literature review of studies on the use of local negative pressure technique (vacuum therapy) in abdominal surgery is presented. The article highlights modern approaches to its use in emergency pathology of the abdominal cavity and retroperitoneal space. The mechanisms of action, advantages and disadvantages of the local negative pressure technique, as well as the main morphofunctional aspects of its application are discussed in detail. Data from recent clinical studies and meta-analyses are summarized, and the effectiveness of using vacuum-assisted laparostomy within the framework of the «damage control» concept in multi-stage surgical treatment of injuries and urgent abdominal diseases accompanied by abdominal sepsis is demonstrated. The use of local negative pressure techniques can reduce postoperative mortality, as well as shorten the length of hospital treatment of patients. However, despite the obvious positive effect on the course of the wound process, vacuum therapy carries the risk of developing serious complications, the most dangerous of which are bleeding and perforation of hollow organs. In addition, it requires very expensive equipment and consumables, as well as training of medical personnel. Thus, the use of vacuum therapy requires a sound approach and a clear understanding of the technical features of its implementation. However, the indications for the use of local negative pressure in abdominal surgery have not yet been clarified, which undoubtedly hinders the wider introduction of this promising technique into clinical practice.

Endoscopic vacuum therapy for nonhealing cavity with fistulous tract after peroral endoscopic myotomy for Zenker’s diverticulum

Video 1Endoscopic vacuum therapy for nonhealing cavity with fistulous tract after peroral endoscopic myotomy for Zenker diverticulum.

Correction: Endoscopic vacuum therapy for anastomotic leakage after upper gastrointestinal surgery.

Correction: Endoscopic vacuum therapy for anastomotic leakage after upper gastrointestinal surgery.

Endoscopic iatrogenic esophageal perforation and management: a retrospective outcome analysis in the modern era

IntroductionIatrogenic esophageal perforation (IEP) is a severe adverse event (AE) of upper endoscopy procedures (UEPs) associated with morbidity. Management has shifted from surgery to endotherapy with clip closure (CC), self-expanding metal stent (SEMS), and vacuum therapy (VT). Limited analyses measure outcomes during contemporary interventional endoscopy periods.MethodsIEPs associated with EGD, upper EUS, small bowel enteroscopy (SBE), and ERCP at a 3-hospital academic center from January 2011 to December 2023 were identified retrospectively from a centralized AE database. Additional information was obtained from medical records. Statistical analysis was performed using Microsoft Excel and STATA.ResultsThirty-two IEPs from 26 EGDs, 4 EUS, 1 SBE, and 1 ERCP were identified. IEPs occurred mostly after dilation (bougie N = 7; balloon, N = 5) or foreign body removal (N = 6). Most IEPs occurred in the lower esophagus (N = 10) or gastroesophageal junction (N = 8). Diagnosis was made at a median 2 h after the injury by endoscopy (N = 14), CT scan (N = 12), esophagram (N = 5), or x-ray (N = 1). Initial treatment included conservative therapy alone (N = 7), CC (N = 3), SEMS (N = 14), SEMS plus CC (N = 3), or surgery (N = 3). Eleven patients required additional treatment including repeat SEMS or adjustment (N = 4) or VT (N = 1). No surgical interventions were required after 2013. The median hospital stay was 3 days. Disposition included discharge to home (N = 25), long-term care facility (N = 2), 4 deaths (12.5% of IEPs), and 1 unknown.ConclusionsIEPs are rare and occur throughout the esophagus after any UEP. The majority are recognized immediately and managed with endotherapy, or rarely, surgery today. These characteristics likely explain the low mortality in this study.

The use of endoscopic vacuum therapy for esophageal rupture

The authors are demonstrating a positive outcome of treatment of a 52-year-old patient using endoscopic vacuum therapy for spontaneous rupture of the esophagus (Burhave syndrome). The patient was discharged after 15 days with epithelization of the defect. Thus, this method, in the form of a combination of use of a special polyurethane sponge and constant aspiration, prevented the development of complications and contributed to the reparation of esophageal rupture.

Clinical Evidence Regarding the Dynamic of Baker Cyst Dimensions after Intermittent Vacuum Therapy as Rehabilitation Treatment in Patients with Knee Osteoarthritis.

The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the semimembranosus and medial head of the gastrocnemius. We aimed to evaluate the effectiveness of physiotherapy (10 days of treatment) that associates intermittent vacuum therapy (IVT) on the lower limbs in the treatment of the BC, respectively, in its size reduction. Sixty-five patients with knee osteoarthritis using Kellgren-Lawrence criteria and the presence of BC (ultrasonography evaluation), were divided into the Control and Vacuum groups. We collected the following features: sex, age, level of education, occupation, environment, body mass index, Knee Injury and Osteoarthritis Outcome Score, Western Ontario, and McMaster Universities Osteoarthritis Index, the Functional Independence Measurement, the Fall Risk Score, and the Visual Analog Scale were recorded at baseline and after 10 days. Both groups are similar in terms of demographic features. Regarding the clinical functional parameters, the results elicit a statistically significant change in all parameters between admission and discharge, including the echo volume at BC. Physical medicine and rehabilitation increase the autonomy of patients with BC. Clinical-functional improvement begins in the first 10 days of complex rehabilitation treatment; it is statistically significant and is not different between the two groups, which brings an additional argument for the effectiveness of conservative therapy in the treatment of BC. Although IVT has not demonstrated its superiority over classical balneo-physical therapy, additional research, and long-term monitoring are needed to provide additional arguments regarding this aspect.

Diagnosis and management of anastomotic leaks after Ivor Lewis esophagectomy: a single-center experience.

Esophageal anastomotic leaks (ALs) after esophagectomy are a common and serious complication. The incidence, diagnostic approach, and management have changed over time. We described the diagnosis and management of patients who developed an esophageal AL after an Ivor Lewis esophagectomy at our center. After IRB approval, we queried our prospectively maintained database for patients who developed an esophageal AL after esophagectomy from August 2016 through July 2022. Data pertaining to demographics, comorbidities, surgical and oncological characteristics, and clinical course were extracted and analyzed. During the study period, 145 patients underwent an Ivor Lewis esophagectomy; 10 (6.9%) developed an AL, diagnosed a median of 7.5days after surgery, and detected by enteric contents in wound drains (n = 3), endoscopy (n = 3), CT (n = 2), and contrast esophagogram (n = 2). Nine patients (90%) had an increasing white blood cell count and additional signs of sepsis. One asymptomatic patient was identified by contrast esophagography. All patients received enteral nutritional support, intravenous antibiotics, and antifungals. Primary treatment of ALs included endoscopic placement of a self-expanding metal stent (SEMS; n = 6), surgery (n = 2), and SEMS with endoluminal vacuum therapy (n = 2). One patient required surgery after SEMS placement. The median length ofICU and total hospital stays were 11.5 and 22.5days, respectively. There was no 30-day mortality. The incidence of esophageal ALs at our center is similar to that ofother high-volume centers. Most ALs can be managed without surgery; however, ALs remain a significant source of postoperative morbidity despite clinical advancements that have improved mortality.

Efficacy of endoluminal vacuum therapy for the treatment of a rectal leak after endoscopic submucosal dissection

Efficacy of endoluminal vacuum therapy for the treatment of a rectal leak after endoscopic submucosal dissection

Endoscopic vacuum therapy for esophageal perforations: is it risk effective for every size of defect?

Endoscopic vacuum therapy for esophageal perforations: is it risk effective for every size of defect?

Endoscopic Vacuum Therapy for Upper Gastrointestinal Leaks and Perforations: Analysis From a Multicenter Spanish Registry.

Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5-133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15-5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.

Management of a gastric pouch staple-line leak and its adverse events with multimodal endoscopic techniques including endoscopic vacuum therapy.

Video 1Management of a gastric pouch staple-line leak and its adverse events with multimodal endoscopic techniques including endoscopic vacuum therapy.

Endoscopic vacuum therapy as a first-line treatment option for gastric leaks after bariatric surgery: evidence from 10 years of experience.

Gastric (anastomotic or staple-line) leaks after bariatric surgery are rare but potentially life-threatening complications. Endoscopic vacuum therapy (EVT) has evolved as the most promising treatment strategy for leaks associated with upper gastrointestinal surgery. The aim of this study was to evaluate the efficiency of our gastric leak management protocol in all bariatric patients over a 10-year period. Special emphasis was placed on EVT treatment and its outcome as a primary treatment or as a secondary treatment when other approaches failed. This study was performed at a tertiary clinic and certified center of reference for bariatric surgery. In this retrospective single-center cohort study, clinical outcomes of all consecutive patients after bariatric surgery from 2012 to 2021 are reported, with special emphasis placed on gastric leak treatment. The primary endpoint was successful leak closure. Secondary endpoints were overall complications (Clavien-Dindo classification) and length of stay. A total of 1046 patients underwent primary or revisional bariatric surgery, of whom 10 (1.0%) developed a postoperative gastric leak. Additionally, 7 patients were transferred for leak management after external bariatric surgery. Of these, 9 patients underwent primary and 8 patients underwent secondary EVT after futile surgical or endoscopic leak management. The efficacy of EVT was 100%, and there were no deaths. Complications did not differ between primary EVT and secondary treatment of leaks. Length of treatment was 17 days for primary EVT versus 61 days for secondary EVT (P = .015). EVT for gastric leaks after bariatric surgery led to rapid source control with a 100% success rate both as primary and secondary treatment. Early detection and primary EVT shortened treatment time and length of stay. This study underlines the potential of EVT as a first-line treatment strategy for gastric leaks after bariatric surgery.

224. A SUCCESSFUL CASE OF VACUUM-STENT TREATMENT FOR BOERHAAVE SYNDROME

Abstract Background Boerhaave syndrome is a rare disease, associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has gained a greater role in the treatment of transmural defects in the upper gastrointestinal tract, including Boerhaave syndrome. Recently, a vacuum-stent was introduced as a new device to apply EVT. While allowing for oral intake of a soft diet, this device combines the benefits of negative pressure wound therapy and an intraluminal stent. Methods This video describes a patient with Boerhaave syndrome, successfully treated with a vacuum-stent, including the technical aspects of the technique. First, a guidewire was placed and the vacuum-stent was advanced over the guidewire and introduced into the esophagus. The vacuum-stent was placed over the defect and deployed using the distal release system. Lastly, the vacuum-stent was connected to a vacuum pump, which was set to a pressure of -125 mmHg on the day of placement and -75 mmHg from the second day on. Generally, a vacuum-stent was removed after 7 days. If the defect persisted, another vacuum-stent was placed. Case/Results: A 36-year-old male presented with severe abdominal pain after emesis. CT-scan showed suspicion of a defect in the distal esophagus and an endoscopy was performed. Endoscopy showed a defect of 2 cm in length with moderate degree of debris. It was decided to initiate treatment with vacuum-stent. The vacuum stent was exchanged once per week and after a total of 31 days, the defect was closed, confirmed by CT-scan with oral contrast. During treatment, oral intake was extended to a soft diet. One day after removal, the patient resumed oral intake and was discharged. Conclusions The vacuum-stent seems to be a safe and possibly organ-saving treatment option for transmural defects in the upper gastrointestinal tract, including Boerhaave syndrome. Link to video: https://we.tl/t-IA5oM70TX5

332. NO NEED FOR A SPONGE! ENDOLUMINAL VACUUM THERAPY WITH A SIMPLE FENESTRATED SURGICAL DRAIN FOR MANAGEMENT OF BENIGN OESOPHAGEAL PERFORATIONS

Abstract Background Conventional endoluminal vacuum therapy (EVT) uses a sponge and can be an effective technique for management of benign esophageal perforations. We describe a unique method of positioning a simple fenestrated surgical drain with applied vacuum suction at or through the site of perforation. We aimed to see whether this was a safe and effective management approach for benign esophageal perforations whilst reducing the frequency and need for general anaesthetic (GA) based endoscopic exchanges. Methods A retrospective case-series was performed on consecutive patients with benign esophageal perforations from 2019 to 2023 at a tertiary hospital in the United Kingdom. Included patients had undergone initial management of benign esophageal perforation with EVT and fenestrated surgical drain. The drain was either placed in an intraluminal or intracavitary position depending on the size of perforation. Primary outcome assessed was complete epithelialisation of the fistulous orifice with EVT. Secondary outcomes included: 90-day mortality, Length of Stay (LOS), re-operation, complications, percentage of EVT procedures under GA, duration of EVT and interval between endoscopic exchanges. Results Seven patients met inclusion criteria (median age: 66 (23–79) years). In four instances aetiology of perforation was iatrogenic from gastroscopic procedures with remaining cases due to Boerhaave’s syndrome, foreign body ingestion and benign ulceration. Six patients achieved full healing of perforation with EVT, with one patient requiring oesophageal stenting. There was 0%, 90-day mortality and two patients underwent re-operation for thoracic drainage procedures. Median LOS was 22 days and mean duration of EVT was 14 days. Patients underwent on average 2.6 gastroscopies during admission, 75% of which were performed without GA. The mean interval between EVT repositioning/exchange was 8 days. Conclusion EVT with a surgical drain achieved complete healing in all but one case of benign esophageal perforation. In contrast to EVT with sponge it can be performed without GA and with a longer duration between drain exchanges and gastroscopies. Additionally, as the same drain can be used for the duration of therapy it may reduce material cost. Further studies should perform prospective and direct comparisons with alternative EVT strategies for benign esophageal perforations.