Endoluminal Vacuum Therapy for Esophageal Injuries: Exploratory Analysis of Success

Endoluminal vacuum therapy (EVT) is a promising treatment for esophageal leaks, perforations, and fistulas, but evidence guiding treatment optimization is limited. In this study, we aimed to identify possible clinical and biological predictors of EVT success.

This is a single-center retrospective review of all patients who underwent EVT from 2020 to 2025. The primary outcome was EVT success, defined as full closure or reduction of defect size, or failure, defined as nonprogression or increase of defect size at the completion of therapy.

Forty-nine patients underwent EVT during the study period. Thirty-nine patients (79.6%) achieved treatment benefit and 10 (20.4%) failed. Indications were leak in 31 patients (63.3%), perforation in 12 (24.5%), and esophageal-airway fistula in six (12.2%). Successful patients had a higher median body mass index (27.1 versus 21.4 kg/m², P < 0.01), higher post-treatment albumin (3.20 versus 2.45 g/dL, P < 0.01), lower white blood cell count (9.26 versus 18.02 K/μL, P = 0.04), and were less likely to be septic (22% versus 70%, P < 0.01). Although successful cases had a smaller defect size (0.2 versus 2.0 cm, P = 0.04), defects up to 4 cm were successfully treated. EVT was equally effective for all presenting problems (leak, perforation, or fistula), causes of injury, or defect location. Mortality occurred in three failed cases, none with successful treatment.

EVT is a promising, versatile tool for the treatment of esophageal leaks, perforations, and fistulas. Markers of nutritional optimization and infection severity correlate with treatment success, and further prospective trials are necessary to establish nutritional optimization and sepsis control protocols.