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Updated: Jan 11, 2026
Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
Endoluminal vacuum therapy for upper gastrointestinal leaks: safe, effective and minimally invasive - insights from a
María Sánchez-Rodríguez1, Laura Monge-Brandi2, Javier García-Lledó3
1General Surgery Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain. mariasanchezrdguez@gmail.com.
Background:
Upper gastrointestinal (UGI) leaks are serious complications with high morbidity and mortality. Endoluminal vacuum therapy (EVT) has emerged as a minimally invasive alternative to surgical management, offering promising outcomes. However, EVT remains a non-standardized technique and data regarding its effectiveness remain heterogeneous.
Methods:
we conducted an observational, retrospective, single-center study from the cohort of patients with UGI leaks treated with EVT at Hospital General Universitario Gregorio Marañón between January 2019 and December 2024. Patient demographics, leak etiology, EVT technical details, complications, and outcomes were analyzed. Overall analysis of the sample and subgroups analysis regarding the leak etiology were conducted. The primary endpoint was leak resolution. Secondary endpoints included morbidity and mortality, number of sponge exchanges, duration of therapy and need for additional interventions.
Results:
30 patients were included; 19 (63.3%) esophaguectomy-associated leaks, 1 (3.3%) esophagueal iatrogenic perforation, 3 (10.0%) gastrectomy-associated leaks and 7 (23.3%) sleeve gastrectomy-associated leaks. EVT achieved leak closure in 27/30 patients (90.0%), combined with endoscopic consolidation therapy in 55%, with a median of 5 (3.0-6.0) sponge exchanges and a median healing time of 30 (18.0-41.0) days. EVT was applied intracavitary in 66.7% in a median time of 1 (0.0-6.0) day since the leak diagnosis and complications occurred in 5/30 (16.6%), all minor. Subgroup analysis revealed a higher success rates and faster recovery in leaks after gastrectomy and esophagectomy. Median hospital stay was 46 (35.0-71.0) days and there was no mortality related to the leak.
Conclusions:
our sample analysis revealed EVT as an effective and safe therapeutic option for managing UGI leaks, with high success rates and low morbidity. Nevertheless, its combined use with endoscopic consolidation therapy may enhance outcomes. Given the limitations of our study, further prospective, multicenter studies are needed to extrapolate our findings and contribute to standardize EVT indications, implementation, and patient selection criteria.
