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Endoscopic Vacuum Therapy (EVT) for the Treatment of Post-Bariatric Surgery Leaks and Fistulas: a Systematic Review and Meta-analysis

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Abstract

Bariatric surgery remains the most effective treatment for morbid obesity and its comorbidities. However, post-surgical leaks and fistulas can occur in about 1–5% of patients, with challenging treatment approaches. Endoscopic vacuum therapy (EVT) has emerged as a promising tool due to its satisfactory results and accessibility. In this first systematic review and meta-analysis on the subject, EVT revealed rates of 87.2% clinical success, 6% moderate adverse events, and 12.5% system dislodgements, requiring 6.47 EVT system exchanges every 4.39 days, with a dwell time of 25.67 days and a total length of hospitalization of 44.43 days. Although our results show that EVT is a safe and effective therapy for post-surgical leaks and fistulas, they should be interpreted with caution due to the paucity of available data.

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Authors and Affiliations

  1. Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil

    Josselyn Mariana Vera Intriago, Diogo Turiani Hourneaux de Moura, Epifanio Silvino do Monte Junior, Igor Mendonça Proença, Igor Braga Ribeiro, Wanderley Marques Bernardo & Eduardo Guimarães Hourneaux de Moura

  2. Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA

    Sergio A. Sánchez-Luna

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  1. Josselyn Mariana Vera Intriago
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Contributions

Vera Intriago JM: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; de Moura DTH: analysis and interpretation of data, revising the article; Proença IM and Monteiro Junior ES: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Ribeiro IB: drafting the article, revising the article, final approval; Sánchez-Luna SA: drafting the article, linguistic correction, revising the article, final approval; Bernardo WM: analysis and interpretation of data, drafting the article, final approval; de Moura EGH: analysis and interpretation of data, drafting the article, revising the article, final approval.

Corresponding author

Correspondence to Igor Braga Ribeiro.

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Ethics Approval

The study was approved by the Research Ethics Committee. For this type of study, formal consent is not required.

Conflict of Interest

Dr. Diogo Turiani Hourneaux De Moura: BariaTek—Advisory Board Member (Consulting fees). Dr. Sergio A. Sanchéz-Luna: Recipient of the 2021 American Society for Gastrointestinal Endoscopy (ASGE) Endoscopic Training Award by the ASGE and Fujifilm. This was not relevant to this study. Dr. Eduardo Guimaraes Hourneaux De Moura: Olympus—Consultant (Consulting fees), Boston Scientific—Consultant (Consulting fees). They were not relevant to this study.

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Key Points

• Endoscopic vacuum therapy (EVT) showed high clinical success rates in the treatment of post-bariatric surgery leaks and fistulas.

• However, EVT may be associated with multiple endoscopic sessions and a long length of hospital stay.

• Adjunctive therapies could be performed during EVT when needed.

• Incidents such as EVT system dislodgment may occur in around 12.5% of cases. Moderate AEs occurred in 6% of the patients but no mortality or severe adverse events (AEs) related to the EVT were reported.

• Although this systematic review and meta-analysis, the first of its kind on the subject, showed that EVT is a safe and effective therapy, our results should be interpreted with caution due to the paucity of available data.

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Intriago, J.M.V., de Moura, D.T.H., do Monte Junior, E.S. et al. Endoscopic Vacuum Therapy (EVT) for the Treatment of Post-Bariatric Surgery Leaks and Fistulas: a Systematic Review and Meta-analysis. OBES SURG 32, 3435–3451 (2022). https://doi.org/10.1007/s11695-022-06228-0

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