A Novel Hybrid Stent with Endoscopic Vacuum Therapy for Treating Leaks of the Upper Gastrointestinal Tract

Abstract

Introduction: Self-expanding metal stents (SEMS) are an established option for treating leaks in the upper gastrointestinal tract, and endoscopic vacuum therapy (EVT) has become a promising alternative. A novel approach is the use of an esophageal hybrid SEMS (VACStent®), which can maintain esophageal passage during EVT. We present the first study demonstrating successful use of the VACStent® for treating leaks of the upper gastrointestinal tract.

Method: We performed a retrospective, single-center study of all patients who underwent endoscopic stenting with the VACStent® of leaks in the upper gastrointestinal tract.

Results: Indications for treatment with the VACStent® were: iatrogenic esophageal perforation (n = 1), spontaneous perforation (n = 2), esophageal fistula (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 5). Successful application of the VACStent® was achieved in all patients (n = 10; 100%) with a total of 15 interventions. VACStent® therapy was used as a first-line treatment in 5 patient (success rate 80%; 4 out 5 patients) and as a second-line treatment after failed previous endoscopic therapy in 5 patients (success rate 60%; 3 out of 5 patients). Overall, VACStent® treatment was successful in 70% of the patients (7 out of 10). No severe VACStent® treatment-related adverse events occurred.

Conclusion: The initial experience has been that the technical application of the VACStent® is safe and technically feasible. However, due to the small number of patients this study could not show the clear advantages of this novel hybrid stent. More studies are necessary to show significant advantages.

Keywords: Anastomotic leak; Endoscopic vacuum therapy; Esophageal perforation; Self-expanding metal stent.