Pull-through endoscopic vacuum-assisted closure therapy for complicated leaks of the gastrointestinal tract – a novel technique

Abstract

Background and study aims Endoscopic vacuum-assisted closure (EVAC) of post-surgical leaks is an increasingly applied technique. Precise intracavitary sponge placement is technically challenging. Here, we describe a novel EVAC therapy using a combined external and endoluminal, pull-through technique. Patients and methods In this retrospective cohort study, we included all patients treated with pull-through EVAC for post-surgery leaks. During endoscopy, the proximal tip of the percutaneous drainage was visualized within the extraluminal abscess cavity, grasped with forceps, and pulled out orally while maintaining the distal end of the drainage above skin level. A foam sponge was fixed to the tip of the percutaneous drainage and sutured to a gastric tube at the other end. The sponge was placed in the cavity by pulling at the percutaneous drainage. Finally, the gastric probe was channeled nasally and suction was applied. Re-interventions comprised pulling the gastric tube, exchanging the sponge, and re-positioning, as described above. Therapy was stopped after closure or complete epithelialization of the leakage. Results Overall, 7 patients were included between 2021 and 2023. Median duration of pull-through EVAC therapy was 30 days (IQR 11 – 37 days) and median number of endoscopic interventions was 6 (IQR 4 – 10). Technical and clinical success was achieved in all (100%) and in 6 of 7 patients (85.7%), respectively. In total, one major bleeding complication associated with EVAC therapy occurred (14.3%). Conclusion Pull-through EVAC therapy is safe and effective in patients with large and challenging post-surgical leaks of the upper GI tract.