Staged endoscopic management of esophageal anastomotic dehiscence using vacuum therapy: experience from two cases

Esophageal anastomotic dehiscence is one of the most serious complications after esophageal surgery. In recent years, endoscopic vacuum therapy (EVT) has become established as an effective alternative to surgical management, as it promotes local infection control and progressive defect closure. However, in clinical practice, uncertainty remains regarding which device should be used at each stage and when the strategy should be modified. Our contribution is to describe a pragmatic two-step, staged approach: initial use of EsoSponge® when the main priority is active drainage of the cavity and local septic control, followed by VACStent® when a small or partially collapsed residual cavity persists and it is desirable to maintain the vacuum effect while also achieving luminal sealing and progression to oral intake. We believe that this sequence may be particularly useful in leaks not completely resolved with conventional EVT, once initial clinical control has been achieved and cavity reduction has been observed.