Modified low-cost EndoVac is safe and efficacious for treatment of postoperative leaks even at low pressures

Postoperative gastrointestinal leaks are often treated using Endoscopic Vacuum therapy (EndoVac). We aim to study the role of modified low-cost EndoVac (mEndoVac) for treatment of postoperative leaks when used at low pressure for upper GI and standard pressure for lower GI leaks.

Retrospective review of prospectively maintained endoscopy database from January 2022 till March 2024 was done for patients who underwent treatment for upper and lower GI leaks using mEndoVac. All upper GI leaks were treated with low pressure (25-30 mmHg-modulated using Sinapi™) while lower GI leaks were treated with standard high pressure (125-150 mmHg). The primary outcome was clinical success (resolution of leak cavity).

Eighteen patients underwent mEndoVac for anastomotic leaks (14 post-esophagectomy leaks, 4 rectal leaks). mEndoVac therapy was started at median 6 days after detection of leak. Intracavitatory mEndoVac placement was done in all patients. Median of 3.5 sessions (2-7) were done. Clinical success was achieved in 88.8% cases (16/18). Mortality at 6 months was seen in 3 cases (16.6%). Complications were seen in 5 (27.7%) patients (all mild).

mEndoVac is safe and effective even at lower pressure for upper GI leaks and at standard pressure for lower GI leaks.