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Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?

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Abstract

Purpose of review

This article provides a comprehensive review of the endoscopic treatment of non-malignant esophageal perforation (NMEP), highlighting endoscopic vacuum therapy (EVT) and its benefits compared to other therapies based on the available data and in our experience in the management of this condition.

Recent findings

The treatment of NMEP is challenging, often being a life-threatening situation. Historically, the management was always performed surgically, although associated with significant morbidity and mortality. Less invasive approaches such as endoscopic therapies are now preferred for clinically stable patients. There is no data to state a gold standard approach; thus, treatment needs to be individualized. EVT use is increasing worldwide due to its unique mechanism of action and satisfactory outcomes.

Summary

EVT should be considered the best approach for NMEP, except for clinically unstable patients with uncontained collection. EVT has an adequate safety profile and presents a higher clinical success rate than any other endoscopic therapies for NMEP as a primary or rescue therapy, as an individual or adjunctive therapy, in defect with or without associated collection, regardless of defect location or duration. Thus, we are positive that it is time to go vacuum for NMEP!

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References and Recommended Reading

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  1. Karstens K-F, Bellon E, Tachezy M, Izbicki JR, Ghadban T, Duprée A, et al. Surgical management of non-malignant esophageal perforations: a single-center analysis over a 15-year period. Dig Surg. 2020;37:302–11. https://doi.org/10.1159/000504342.

    Article  PubMed  Google Scholar 

  2. Watkins JR, Farivar AS. Endoluminal therapies for esophageal perforations and leaks. Thorac Surg Clin. 2018;28:541–54. https://doi.org/10.1016/j.thorsurg.2018.07.002.

    Article  PubMed  Google Scholar 

  3. de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: basic principles and recommendations. World J Gastroenterol. 2023;29: 1173–93. https://doi.org/10.3748/wjg.v29.i7.1173. This is a complete review of endoscopic management of leaks and fistulas. All endoscopists treating these challenge conditions should read it.

  4. Bestetti AM, Boghossian MB, Hirsch BS, McCarty TR, Santo MA, de Moura EGH, et al. Multiple endoscopic therapies for treatment of chronic post-bariatric surgery gastropleural fistula. Obes Surg. 2022;32:3206–7. https://doi.org/10.1007/s11695-022-06186-7.

    Article  PubMed  Google Scholar 

  5. de Moura DTH, Sachdev AH, Thompson CC. Endoscopic full-thickness defects and closure techniques. Curr Treat Options Gastroenterol. 2018;16:386–405. https://doi.org/10.1007/s11938-018-0199-6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. de Moura DTH, de Moura BFBH, Manfredi MA, Hathorn KE, Bazarbashi as, Ribeiro IB, et al. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc. 2019;11:329–44. https://doi.org/10.4253/wjge.v11.i5.329. This is a complete review of endoscopic vacuum therapy for management of gastrointestinal transmural defects.

  7. Cho J, Sahakian AB. Endoscopic closure of gastrointestinal fistulae and leaks. Gastrointest Endosc Clin N Am. 2018;28:233–49. https://doi.org/10.1016/j.giec.2017.11.010.

    Article  PubMed  Google Scholar 

  8. do Monte Junior ES, de Moura DTH, Ribeiro IB, Hathorn KE, Farias GFA, Turiani CV, et al. Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: systematic review and meta-analysis. Dig Endosc. 2021;33:892–902. https://doi.org/10.1111/den.13813. This is a systematic review and meta-analysis comparing endoscopic vacuum therapy versus stents for upper gastrointestinal transmural defects, showing favoring results for EVT.

  9. Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, et al. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices. 2019;16:197–209. https://doi.org/10.1080/17434440.2019.1582329. This is a complete review of endoscopic vacuum therapy for management of esophageal perforation, leaks, and fistulas.

  10. Kupeli M, Dogan A. Successful treatment of a late diagnosed esophageal perforation with mediastinitis and pericardial abscess. J Coll Physicians Surg Pak. 2018;28:972–3. https://doi.org/10.29271/jcpsp.2018.12.972.

    Article  PubMed  Google Scholar 

  11. Milosavljevic T, Popovic D, Zec S, Krstic M, Mijac D. Accuracy and pitfalls in the assessment of early gastrointestinal lesions. Dig Dis. 2019;37:364–73. https://doi.org/10.1159/000495849.

    Article  PubMed  Google Scholar 

  12. Zhang X, Liu J, Li J, Hu J, Yu F, Li S, et al. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. Laryngoscope. 2011;121:267–72. https://doi.org/10.1002/lary.21366.

    Article  PubMed  Google Scholar 

  13. Mardin WA, Palmes D, Bruewer M. Current concepts in the management of leakages after esophagectomy. Thorac Cancer. 2012;3:117–24. https://doi.org/10.1111/j.1759-7714.2012.00117.x.

    Article  PubMed  Google Scholar 

  14. Horvath P, Lange J, Stüker D, Wichmann D, Hilbert J, Götz M, et al. Multimodal treatment strategies for esophageal perforation. Surg Laparosc Endosc Percutan Tech. 2018;28:232–8. https://doi.org/10.1097/SLE.0000000000000549.

    Article  PubMed  Google Scholar 

  15. de Schipper JP, Pull ter Gunne AF, Oostvogel HJM, van Laarhoven CJHM. Spontaneous rupture of the oesophagus: Boerhaave’s syndrome in 2008. Literature review and treatment algorithm. Dig Surg. 2009;26:1–6. https://doi.org/10.1159/000191283.

    Article  PubMed  Google Scholar 

  16. Rodrigues-Pinto E, Repici A, Donatelli G, Macedo G, Devière J, van Hooft JE, et al. International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks. Endosc Int Open. 2019;7:E1671–82. https://doi.org/10.1055/a-1005-6632.

    Article  PubMed  PubMed Central  Google Scholar 

  17. de Moura DTH, Dantas ACB, Ribeiro IB, McCarty TR, Takeda FR, Santo MA, et al. Status of bariatric endoscopy-what does the surgeon need to know? A review. World J Gastrointest Surg. 2022;14:185–99. https://doi.org/10.4240/wjgs.v14.i2.185. This review discusses the endoscopic management of post-surgical leaks and fistulas.

  18. Barrichello Junior SA, Ribeiro IB, Fittipaldi-Fernandez RJ, Hoff AC, de Moura DTH, Minata MK, et al. Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review. Endosc Int Open. 2018;6:E1322–9. https://doi.org/10.1055/a-0743-5520.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sachdev AH, Iqbal S, Ribeiro IB, de Moura DTH. Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: a series of cases. World J Clin Cases. 2020;8:120–5. https://doi.org/10.12998/wjcc.v8.i1.120.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bestetti AM, Santo MA, Trasolini RP, de Freitas Junior JR, Hirsch BS, de Moura EGH, et al. Sequential endoscopic therapies for treatment of complex gastrointestinal transmural leak following bariatric surgery. Obes Surg. 2022;32:4113–4. https://doi.org/10.1007/s11695-022-06311-6.

    Article  PubMed  Google Scholar 

  21. Stavropoulos SN, Modayil R, Friedel D. Closing perforations and postperforation management in endoscopy: esophagus and stomach. Gastrointest Endosc Clin N Am. 2015;25:29–45. https://doi.org/10.1016/j.giec.2014.09.008.

    Article  PubMed  Google Scholar 

  22. de Moura EG, Silva GL, de Moura ET, Pu LZ, de Castro VL, de Moura DT, Sallum RA. Esophageal perforation after epicardial ablation: an endoscopic approach. Endoscopy. 2015;47:E592–3. https://doi.org/10.1055/s-0034-1393594.

    Article  PubMed  Google Scholar 

  23. Bartell N, Bittner K, Kaul V, Kothari TH, Kothari S. Clinical efficacy of the over-the-scope clip device: A systematic review. World J Gastroenterol. 2020;26:3495–516. https://doi.org/10.3748/wjg.v26.i24.3495.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Law R, Prabhu A, Fujii-Lau L, Shannon C, Singh S. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc. 2018;32:675–81. https://doi.org/10.1007/s00464-017-5720-9.

    Article  PubMed  Google Scholar 

  25. de Moura DTH, Baptista A, Jirapinyo P, de Moura EGH, Thompson C. Role of cardiac septal occluders in the treatment of gastrointestinal fistulas: a systematic review. Clin Endosc. 2020;53:37–48. https://doi.org/10.5946/ce.2019.030.

    Article  PubMed  Google Scholar 

  26. Boghossian MB, Funari MP, do Monte Junior ES, Rocha RSP, de Moura DTH, de Souza TF, de Moura EGH. Endoscopic septotomy for fistula after bariatric surgery. Endoscopy. 2022;54:E38–9. https://doi.org/10.1055/a-1375-0159.

  27. de Moura DTH, de Freitas Júnior JR, de Souza GMV, de Oliveira GHP, McCarty TR, Thompson CC, de Moura EGH. Endoscopic management of acute leak after sleeve gastrectomy: principles and techniques. Endoscopy. 2022;54:E327–8. https://doi.org/10.1055/a-1525-1661. This case report discusses the pivotal principals for the treatment of post-surgical leaks.

  28. Oung B, Rostain F, Rivory J, Boibieux A, Schoch A, Mion F, Pioche M. Infected esophageal subepithelial hematoma after peroral endoscopic myotomy for achalasia successfully treated with double-pigtail stent drainage. Endoscopy. 2020;52:E237–8. https://doi.org/10.1055/a-1085-2579.

    Article  PubMed  Google Scholar 

  29. Sánchez-Luna SA, Guimãraes Hourneaux De Moura E, Sena de Medeiros F, Turiani Hourneaux De Moura D. Does it matter which plastic stents we use for the treatment of post-surgical leaks? Or does one-size-fit-all? Rev Esp Enferm Dig. 2022;114:181–2. https://doi.org/10.17235/reed.2021.8433/2021.

  30. Mastoridis S, Chana P, Singh M, Akbari K, Shalaby S, Maynard ND, Sgromo B. Endoscopic vacuum therapy (EVT) in the management of oesophageal perforations and post-operative leaks. Minim Invasive Ther Allied Technol. 2022;31:380–8. https://doi.org/10.1080/13645706.2020.1801753.

    Article  PubMed  Google Scholar 

  31. Tavares G, Tustumi F, Tristão LS, Bernardo WM. Endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy: a systematic review and meta-analysis. Dis Esophagus. 2021;34:doaa132. https://doi.org/10.1093/dote/doaa132.

  32. Gregory S, Chun RH, Parakininkas D, Amos L, Fons R, Lerner DG, Lal DR, Sulman C. Endoscopic esophageal and tracheal cauterization for closure of recurrent tracheoesophageal fistula: a case report and review of the literature. Int J Pediatr Otorhinolaryngol. 2017;98:158–61. https://doi.org/10.1016/j.ijporl.2017.04.051.

    Article  PubMed  Google Scholar 

  33. Loske G, Schorsch T, Rucktaeschel F, Schulze W, Riefel B, van Ackeren V, Mueller CT. Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT). Endosc Int Open. 2018;6:E865–71. https://doi.org/10.1055/a-0599-5886. This article discusses important principals regarding endoscopic vacuum therapy.

  34. Loske G, Müller CT. Tips and tricks for endoscopic negative pressure therapy. Chirurg. 2019;90:7–14. https://doi.org/10.1007/s00104-018-0725-z. This article discusses important principals regarding endoscopic vacuum therapy. All endoscopists performing this therapy should read it.

  35. Weidenhagen R, Gruetzner KU, Spelsberg F, Lang RA, Jauch K-W. A new method for sepsis control caused by anastomotic leakage in rectal surgery - the ENDO-VAC®. Shock. 2004;21:152. https://doi.org/10.1097/00024382-200403001-00608.

    Article  Google Scholar 

  36. de Moura DTH, Hirsch BS, do Monte Junior ES, McCarty TR, de Medeiros FS, Thompson CC, 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;6:523–8. https://doi.org/10.1016/j.vgie.2021.08.002. This video-article describes in detail how to manufacture the homemade-EVT. All endoscopists performing this therapy should read it.

  37. de Moura DTH, do Monte Junior ES, Hathorn KE, de Medeiros FS, Thompson CC, de Moura EGH. Modified endoscopic vacuum therapy in the management of a duodenal transmural defect. Endoscopy. 2021;53:E17–8. https://doi.org/10.1055/a-1173-7282.

  38. Gutschow CA, Schlag C, Vetter D. Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it. Langenbecks Arch Surg. 2022;407:957–64. https://doi.org/10.1007/s00423-022-02436-5. This article discusses important principals regarding endoscopic vacuum therapy. All endoscopists performing this therapy should read it.

  39. Stathopoulos P, Zumblick M, Wächter S, Schiffmann L, Gress TM, Bartsch D, et al. Endoscopic vacuum therapy (EVT) for acute esophageal perforation: could it replace surgery? Endosc Int Open. 2022;10:E686–93. https://doi.org/10.1055/a-1781-0827.

    Article  PubMed  PubMed Central  Google Scholar 

  40. de Moura DTH, Hirsch BS, McCarty TR, Lera Dos Santos ME, Guedes HG, Gomes GF, et al. Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects. Dig Endosc. 2023. https://doi.org/10.1111/den.14518. This article discusses important principals regarding endoscopic vacuum therapy.

  41. de Moura DTH, Brunaldi VO, Minata M, Riccioppo D, Santo MA, de Moura EGH. Endoscopic vacuum therapy for a large esophageal perforation after bariatric stent placement. VideoGIE. 2018;3:346–8. https://doi.org/10.1016/j.vgie.2018.08.009.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Livingstone I, Pollock L, Sgromo B, Mastoridis S. Current status of endoscopic vacuum therapy in the management of esophageal perforations and post-operative leaks. Clin Endosc. 2021;54:787–97. https://doi.org/10.5946/ce.2021.240. This is a review regarding the use of endoscopic vacuum therapy for esophageal perforation and post-operative leaks.

  43. Intriago JMV, de Moura DTH, do Monte Junior ES, Proença IM, Ribeiro IB, Sánchez-Luna SA, et al. Endoscopic vacuum therapy (EVT) for the treatment of post-bariatric surgery leaks and fistulas: a systematic review and meta-analysis. Obes Surg. 2022;32:3435–51. https://doi.org/10.1007/s11695-022-06228-0.

  44. Ribeiro Jordão Sasso JG, Yvamoto EY, Rocha RSP, Ribeiro IB, Boghossian MB, de Moura DTH, de Moura EGH. Modified endoscopic vacuum therapy for hypopharyngeal acute leakage after foreign body perforation. Endoscopy. 2022;54:E1022–3. https://doi.org/10.1055/a-1901-0829.

  45. Aziz M, Haghbin H, Sharma S, Weissman S, Saleem S, Lee-Smith W, Kobeissy A, Nawras A, Alastal Y. Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: systematic review and meta-analysis. Endosc Int Open. 2021;9:E1371–80. https://doi.org/10.1055/a-1508-5947.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Scognamiglio P, Reeh M, Melling N, Kantowski M, Eichelmann AK, Chon SH, El-Sourani N, Schön G, Höller A, Izbicki JR, Tachezy M. Management of intra-thoracic anastomotic leakages after esophagectomy: updated systematic review and meta-analysis of endoscopic vacuum therapy versus stenting. BMC Surg. 2022;22:309. https://doi.org/10.1186/s12893-022-01764-z. This is the last meta-analysis comparing endoscopic vacuum therapy versus stent for management of intra-thoracic anastomotic leaks proving that EVT is superior to stent.

  47. Scognamiglio P, Reeh M, Karstens K, Bellon E, Kantowski M, Schön G, Zapf A, Chon SH, Izbicki JR, Tachezy M. Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis. Endoscopy. 2020;52:632–42. https://doi.org/10.1055/a-1149-1741.

    Article  PubMed  Google Scholar 

  48. Laukoetter MG, Mennigen R, Neumann PA, Dhayat S, Horst G, Palmes D, Senninger N, Vowinkel T. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. 2017;31:2687–96. https://doi.org/10.1007/s00464-016-5265-3.

    Article  PubMed  Google Scholar 

  49. Virgilio E, Ceci D, Cavallini M. Surgical endoscopic vacuum-assisted closure therapy (EVAC) in treating anastomotic leakages after major resective surgery of esophageal and gastric cancer. Anticancer Res. 2018;38:5581–7. https://doi.org/10.21873/anticanres.12892.

    Article  PubMed  Google Scholar 

  50. Pournaras DJ, Hardwick RH, Safranek PM, Sujendran V, Bennett J, Macaulay GD, Hindmarsh A. Endoluminal vacuum therapy (E-Vac): a treatment option in oesophagogastric surgery. World J Surg. 2018;42:2507–11. https://doi.org/10.1007/s00268-018-4463-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. de Moura DTH, de Moura EGH, Hirsch BS, Silva GLR, Rizk SI, Hoff PM, et al. Modified endoscopic vacuum therapy for duodenal hemorrhage in patients with severe acute respiratory syndrome coronavirus 2. Endoscopy. 2022;54:E837–9. https://doi.org/10.1055/a-1803-4445.

    Article  PubMed  PubMed Central  Google Scholar 

  52. de Moura DTH, de Moura EGH, Hirsch BS, McCarty TR, Rodela Silva GL, Rizk SI, et al. Endoscopic vacuum therapy for duodenal hemorrhage in critically ill patients with COVID-19. Am J Gastroenterol. 2022;117:688. https://doi.org/10.14309/ajg.0000000000001643. This case series was the first to describe the use of endoscopic vacuum therapy for diffuse gastrointestinal bleeding explaining its mechanisms of action.

  53. de Moura DTH, Hirsch BS, Boghossian MB, de Medeiros FS, McCarty TR, Thompson CC, de Moura EGH. 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. 2022;54:E376–7. https://doi.org/10.1055/a-1540-5870. This video-article describes in detail how to manufacture the triple lumen EVT device. All endoscopists performing this therapy should read it.

  54. Jansen KT, Hetzel J, Schulte C, Düzenli N, Fusco S, Zerabruck E, Schmider E, Malek NP, Königsrainer A, Stüker D, Werner CR, Wichmann D. Differences in fluid removal of different open-pore elements for endoscopic negative pressure therapy in the upper gastrointestinal tract. Sci Rep. 2022;12:13889. https://doi.org/10.1038/s41598-022-17700-3. This study evaluates differences in fluid removal of different EVT devices. All endoscopists performing this therapy should read it.

  55. Simas de Lima M, Uemura RS, Gusmon-Oliveira CC, Pombo AAM, Martins BC, Lenz L, Kawaguti FS, De Paulo GA, Baba ER, Safatle-Ribeiro AV, Ribeiro U Jr, Monkemüller K, Maluf-Filho F. Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations. Endoscopy. 2022;54:980–6. https://doi.org/10.1055/a-1774-4630.

  56. Manfredi MA, Clark SJ, Staffa SJ, Ngo PD, Smithers CJ, Hamilton TE, Jennings RW. Endoscopic esophageal vacuum therapy: a novel therapy for esophageal perforations in pediatric patients. J Pediatr Gastroenterol Nutr. 2018;67:706–12. https://doi.org/10.1097/MPG.0000000000002073.

    Article  PubMed  Google Scholar 

  57. Sánchez-Luna SA, Thompson CC, De Moura EGH, de Medeiros FS, De Moura DTH. Modified endoscopic vacuum therapy: are we ready for prime time? Gastrointest Endosc. 2022;95:1281–2. https://doi.org/10.1016/j.gie.2021.12.049.

    Article  PubMed  Google Scholar 

  58. Valli PV, Mertens JC, Kröger A, Gubler C, Gutschow C, Schneider PM, Bauerfeind P. Stent-over-sponge (SOS): a novel technique complementing endosponge therapy for foregut leaks and perforations. Endoscopy. 2018;50:148–53. https://doi.org/10.1055/s-0043-120442.

    Article  PubMed  Google Scholar 

  59. Lange J, Dormann A, Bulian DR, Hügle U, Eisenberger CF, Heiss MM. VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage. Endosc Int Open. 2021;9:E971–6. https://doi.org/10.1055/a-1474-9932.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Chon SH, Töx U, Lorenz F, Rieck I, Wagner BJ, Kleinert R, Fuchs HF, Goeser T, Quaas A, Bruns CJ. A novel hybrid stent with endoscopic vacuum therapy for treating leaks of the upper gastrointestinal tract. Visc Med. 2021;37:403–9. https://doi.org/10.1159/000512320.

    Article  PubMed  Google Scholar 

  61. Lee JH, Kedia P, Stavropoulos SN, Carr-Locke D. AGA clinical practice update on endoscopic management of perforations in gastrointestinal tract: expert review. Clin Gastroenterol Hepatol. 2021;19:2252–61. https://doi.org/10.1016/j.cgh.2021.06.045.

    Article  PubMed  Google Scholar 

  62. Fritscher-Ravens A, Hampe J, Grange P, Holland C, Olagbeye F, Milla P, von Herbay A, Jacobsen B, Seehusen F, Hadeler KG, Mannur K. Clip closure versus endoscopic suturing versus thoracoscopic repair of an iatrogenic esophageal perforation: a randomized, comparative, long-term survival study in a porcine model (with videos). Gastrointest Endosc. 2010;72:1020–6. https://doi.org/10.1016/j.gie.2010.07.029.

    Article  PubMed  Google Scholar 

  63. Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, Epanomeritakis E. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259:852–60. https://doi.org/10.1097/SLA.0000000000000564.

    Article  PubMed  Google Scholar 

  64. Van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33:1292–301. https://doi.org/10.1111/j.1365-2036.2011.04663.x.

    Article  PubMed  Google Scholar 

  65. Mudumbi S, Velazquez-Aviña J, Neumann H, Kyanam Kabir Baig KR, Mönkemüller K. Anchoring of self-expanding metal stents using the over-the-scope clip, and a technique for subsequent removal. Endoscopy. 2014;46:1106–9. https://doi.org/10.1055/s-0034-1377916.

    Article  PubMed  Google Scholar 

  66. Sánchez-Luna SA, De Moura EGH, De Moura DTH. Bigger is not always better for the endoscopic treatment of sleeve gastrectomy (SG) leaks using fully covered stents. Obes Surg. 2022;32:1764–7. https://doi.org/10.1007/s11695-022-05923-2.

    Article  PubMed  Google Scholar 

  67. Maselli R, Palma R, Traina M, Granata A, Juzgado D, Bisello M, Neuhaus H, Beyna T, Bansi D, Flor L, Bhandari P, Abdelrahim M, Haji A, Haidry R, Repici A. Endoscopic suturing for GI applications: initial results from a prospective multicenter European registry. Gastrointest Endosc. 2022;96:780–6. https://doi.org/10.1016/j.gie.2022.06.004.

    Article  PubMed  Google Scholar 

  68. de Moura EG, Galvão-Neto MP, Ramos AC, de Moura ET, Galvão TD, de Moura DT, Ferreira FC. Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass. Surg Endosc. 2012;26:1481–4. https://doi.org/10.1007/s00464-011-2060-z.

    Article  PubMed  Google Scholar 

  69. Dos Santos NT, De Moura DTH, Galvão Neto M, de Medeiros FS, Nogueira MVF, Thompson CC. Novel laparo-endoscopic hybrid procedure to treat a disconnected Roux limb after bariatric surgery. Endoscopy. 2019;51:E341–2. https://doi.org/10.1055/a-0885-9095.

    Article  PubMed  Google Scholar 

  70. Hamid HKS, Emile SH, Saber AA, Dincer M, de Moura DTH, Gilissen LPL, Almadi MA, Montuori M, Vix M, Perisse LGS, Quezada N, Garofalo F, Pescarus R. Customized bariatric stents for sleeve gastrectomy leak: are they superior to conventional esophageal stents? A systematic review and proportion meta-analysis. Surg Endosc. 2021;35:1025–38. https://doi.org/10.1007/s00464-020-08147-6.

    Article  PubMed  Google Scholar 

  71. de Moura DTH, de Moura EGH, Neto MG, Jirapinyo P, Teixeira N, Orso I, Quadros LG, Amorim A, Medeiros F, Neto DR, de Siqueira NJ, Albano A, de Sousa LH, Almeida D, Marchetti IA, Ivano F, de Lima JHF, Falcão M, Thompson CC. Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis. 2019;15:1241–51. https://doi.org/10.1016/j.soard.2019.05.022.

    Article  PubMed  Google Scholar 

  72. Haito-Chavez Y, Kumbhari V, Ngamruengphong S, De Moura DT, El Zein M, Vieira M, Aguila G, Khashab MA. Septotomy: an adjunct endoscopic treatment for post- sleeve gastrectomy fistulas. Gastrointest Endosc. 2016;83:456–7. https://doi.org/10.1016/j.gie.2015.08.065.

    Article  PubMed  Google Scholar 

  73. Chipkin B, Pandey NK, Schlachterman A. Septal wall divides esophagus into double lumen: successful endoscopic septotomy. VideoGIE. 2022;7:99–101. https://doi.org/10.1016/j.vgie.2021.12.002.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Farias GFA, Bernardo WM, De Moura DTH, Guedes HG, Brunaldi VO, Visconti TAC, Gonçalves CVT, Sakai CM, Matuguma SE, Santos MELD, Sakai P, De Moura EGH. Endoscopic versus surgical treatment for pancreatic pseudocysts: systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e14255. https://doi.org/10.1097/MD.0000000000014255.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis. 2021;17:1432–9. https://doi.org/10.1016/j.soard.2021.03.013.

    Article  PubMed  Google Scholar 

  76. Hourneaux de Moura DT, Jirapinyo P, Hathorn KE, Thompson CC. Use of a cardiac septal occluder in the treatment of a chronic GI fistula: what should we know before off-label use in the GI tract? VideoGIE. 2018;4:114–7. https://doi.org/10.1016/j.vgie.2018.10.011.

  77. Zhou C, Hu Y, Xiao Y, Yin W. Current treatment of tracheoesophageal fistula. Ther Adv Respir Dis. 2017;11:173–80. https://doi.org/10.1177/1753465816687518.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Aworanti O, Awadalla S. Management of recurrent tracheoesophageal fistulas: a systematic review. Eur J Pediatr Surg. 2014;24:365–75. https://doi.org/10.1055/s-0034-1370780.

    Article  PubMed  Google Scholar 

  79. Bustamante Bernal M, Bhat S, Mendoza-Ladd A. Endoscopic closure of a chronic tracheo-esophageal fistula with an over-the-scope suturing technique. Endoscopy. 2018;50:E155–6. https://doi.org/10.1055/a-0593-5447.

    Article  PubMed  Google Scholar 

  80. Benson AA, Hakimian D, Jacob H, Boškoski I. Closure of a chronic complex tracheoesophageal fistula by using endoscopic suturing. VideoGIE. 2020;6:119–21. https://doi.org/10.1016/j.vgie.2020.11.013.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Meier JD, Sulman CG, Almond PS, Holinger LD. Endoscopic management of recurrent congenital tracheoesophageal fistula: a review of techniques and results. Int J Pediatr Otorhinolaryngol. 2007;71:691–7. https://doi.org/10.1016/j.ijporl.2007.02.022.

    Article  PubMed  Google Scholar 

  82. Baptista A, Hourneaux De Moura DT, Jirapinyo P, Hourneaux De Moura EG, Gelrud A, Kahaleh M, et al. Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas. Gastrointest Endosc. 2019;89:671–79.e1. https://doi.org/10.1016/j.gie.2018.11.034.

  83. de Moura DTH, Boghossian MB, Hirsch BS, McCarty TR, Baptista AJ, de Moura EGH. Long-term endoscopic follow-up after closure of a post-bariatric surgery fistula with a cardiac septal defect occluder. Endoscopy. 2022;54:E127–8. https://doi.org/10.1055/a-1422-2631.

    Article  PubMed  Google Scholar 

  84. de Moura DTH, da Ponte-Neto AM, Hathorn KE, do Monte Junior ES, Baptista A, Ribeiro IB, Thompson CC, De Moura EGH. Novel endoscopic management of a chronic gastro-gastric fistula using a cardiac septal defect occluder. Obes Surg. 2020;30:3253–4. https://doi.org/10.1007/s11695-020-04616-y.

  85. Zhang YY, Li S, Yuan XL, Hu B. Aorto-esophageal fistula caused by fishbone ingestion: a case report on staged endovascular and endoscopic treatment. BMC Gastroenterol. 2021;21:46. https://doi.org/10.1186/s12876-021-01624-9.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Takeno S, Ishii H, Nanashima A, Nakamura K. Aortoesophageal fistula: review of trends in the last decade. Surg Today. 2020;50:1551–9. https://doi.org/10.1007/s00595-019-01937-z.

    Article  PubMed  Google Scholar 

  87. Neumann PA, Mennigen R, Palmes D, et al. Pre-emptive endoscopic vacuum therapy for treatment of anastomotic ischemia after esophageal resections. Endoscopy. 2017;49:498–503. https://doi.org/10.1055/s-0042-123188.

    Article  PubMed  Google Scholar 

  88. Gubler C, Vetter D, Schmidt HM, Müller PC, Morell B, Raptis D, Gutschow CA. Preemptive endoluminal vacuum therapy to reduce anastomotic leakage after esophagectomy: a game-changing approach? Dis Esophagus. 2019;32:doy126. https://doi.org/10.1093/dote/doy126.

  89. Adamenko O, Ferrari C, Seewald S, Schmidt J. Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review. Updates Surg. 2022;74:1177–86. https://doi.org/10.1007/s13304-022-01265-x. This review describes the potential benefits of pre-emptive endoscopic vacuum therapy to prevent anastomotic leak after gastrointestinal surgery, especially in high-risk patients.

  90. Hourneaux de Moura DT, Hirsch BS, Vasconcelos KGMC, Siqueira LTB, Silveira SQ, de Moura EGH. A novel less-invasive therapy for a bleeding eroded artery in a giant duodenal ulcer: principles and technical description. iGIE. 2022;1:15–8. https://doi.org/10.1016/j.igie.2022.10.006.

    Article  Google Scholar 

  91. Chon SH, Berlth F, Dratsch T, Plum PS, Lorenz F, Goeser T, Bruns CJ. Outcome of prophylactic endoscopic vacuum therapy for high-risk anastomosis after esophagectomy. Minim Invasive Ther Allied Technol. 2022;31:1079–85. https://doi.org/10.1080/13645706.2022.2051719.

    Article  PubMed  Google Scholar 

  92. Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, Dhillon A, Fragaki M, Gonzalez JM, Repici A, van Wanrooij RLJ, van Hooft JE. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement - Update 2020. Endoscopy. 2020;52:792–810. https://doi.org/10.1055/a-1222-3191.

    Article  PubMed  Google Scholar 

  93. Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, Ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019;14:26. https://doi.org/10.1186/s13017-019-0245-2.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Altorjay A, Kiss J, Vörös A, Bohák A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg. 1997;225:415–21. https://doi.org/10.1097/00000658-199704000-0001.

  95. Rausa E, Asti E, Aiolfi A, Bianco F, Bonitta G, Bonavina L. Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis. Dis Esophagus. 2018;31:doy060. https://doi.org/10.1093/dote/doy060.

  96. Newton NJ, Sharrock A, Rickard R, Mughal M. Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations. Dis Esophagus. 2017;30:1–5. https://doi.org/10.1111/dote.12531.

    Article  CAS  PubMed  Google Scholar 

  97. Kuehn F, Loske G, Schiffmann L, Gock M, Klar E. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc. 2017;31:3449–58. https://doi.org/10.1007/s00464-016-5404-x.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Instituto D’Or de Pesquisa e Ensino, Hospital Vila Nova Star, Rua Dr. Alceu de Campos Rodrigues, 126 – Vila Nova Conceição, São Paulo, 04544-000, Brazil

    Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD, Professor & Eduardo Guimarães Hourneaux de Moura MD, MSc, PhD, Professor

  2. Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD, Professor, Bruno Salomão Hirsch MD, Victor Lira de Oliveira MD, Alexandre Moraes Bestetti MD & Eduardo Guimarães Hourneaux de Moura MD, MSc, PhD, Professor

  3. Instituto D’Or de Pesquisa e Ensino, Hospital São Luiz Morumbi, São Paulo, Brazil

    Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD, Professor & Eduardo Guimarães Hourneaux de Moura MD, MSc, PhD, Professor

  4. Surgery Division, Universidade Federal do Rio Grande do Norte, Natal, Brazil

    Heli Clóvis de Medeiros Neto MD

  5. Department of Pediatric Gastroenterology and Hepatology, Institute for Children and Adolescents, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Bruna Furia Buzetti Hourneaux de Moura MD

  6. Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, USA

    Mouen A. Khashab MD, Professor

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  1. Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD, Professor
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Correspondence to Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD, Professor.

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Dr. Turiani Hourneaux de Moura received personal fees as an Advisory Board member for BariaTek. Dr. Khashab is a consultant for Boston Scientific Corporation, Olympus, Pentax, Medtronic and Apollo, received research support from Boston Scientific, and receives royalties from UpToDate and Elsevier. Dr. Guimarães Hourneaux de Moura received personal fees as a consultant for Olympus and Boston Scientific. All other authors have nothing to disclosure.

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de Moura, D.T.H., Hirsch, B.S., de Medeiros Neto, H.C. et al. Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?. Curr Treat Options Gastro 21, 95–124 (2023). https://doi.org/10.1007/s11938-023-00421-5

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