Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis
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Background/Aims: 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 meta-analysis of the available data on theclinical success rate of EVAC. Methods: Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Poolingwas conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primaryoutcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. Results: In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients beingmen. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate ofpostsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-causehospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. Conclusions: This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapyseems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.
Abstract
Background/Aims: 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 meta-analysis of the available data on theclinical success rate of EVAC. Methods: Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Poolingwas conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primaryoutcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. Results: In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients beingmen. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate ofpostsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-causehospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. Conclusions: This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapyseems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.