Endoscopic vacuum therapy: pitfalls, tips and tricks, insights, and perspectives

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Innovation

Background:

• Transmural gastrointestinal defects (TGIDs) present significant management challenges.
• Endoscopic vacuum therapy (EVT) is an emerging technique for TGID management.
• Existing literature often highlights limitations and challenges associated with EVT adoption.

Purpose of the Study:

• To provide a comprehensive review of endoscopic vacuum therapy (EVT) for transmural gastrointestinal defects (TGIDs).
• To demystify limitations and offer practical solutions for EVT implementation.
• To explore future perspectives, including pre-emptive EVT and novel indications.

Main Methods:

• Literature review of available data on EVT for TGIDs.
• Inclusion of personal clinical experience and practical tips.
• Detailed description of EVT placement, management, and adverse event avoidance.

Main Results:

• EVT demonstrates a unique mechanism of action promoting healing through macro/micro deformation, perfusion changes, exudate control, and bacterial clearance.
• EVT has an adequate safety profile and a higher clinical success rate than other endoscopic therapies for TGID.
• Pre-emptive EVT and novel indications show promising effectiveness in initial studies.

Conclusions:

• EVT is a safe and effective endoscopic therapy for TGIDs, offering a less-invasive alternative.
• Addressing technical and institutional challenges through practical solutions can facilitate wider EVT adoption.
• Future applications of EVT, including pre-emptive use and new indications, hold significant potential for patient care.