Reply to Mandarino et al.

We thank Mandarino et al. for their knowledgeable comments on our study. Most concerns were regarding hypotheses on the best application of endoscopic vacuum therapy (EVT), such as the best vacuum pressure and technique (intraluminal/intracavitary). In current literature, no superiority can be concluded on the best indications for specific techniques, owing to the small sample sizes. Specifically, nonanastomotic esophageal perforations are poorly represented in previous studies; for example, Jung et al. only describe 7/90 patients with benign perforations.

As we have mentioned in the discussion, we agree that many factors regarding the best EVT treatment remain unclear. Therefore, we believe large prospective studies are necessary. Currently, we are establishing a large multicenter prospective cohort for EVT in the upper gastrointestinal tract in the Netherlands, to enable us to answer the open questions and further optimize the technique.

Publication History

Article published online:
27 September 2023