ACUTE ESOPHAGEAL PERFORATION: DOES ENDOSCOPIC VACUUM THERAPY ABANDON SURGERY ?

Aims Endoscopic vacuum therapy (EVT) has been proven to be an effective tool for closure of postoperative anastomotic leaks. We report a series of acute esophageal perforations treated with EVT successfully.

Methods EVT was started immediately after perforation (d0:4 d1:2). After positioning of a gastic feeding tube, the sponge (Esosponge, Braun) was inserted into the esophageal lumen covering the perforation site. Sponge were exchanged twice a week until complete endoscopic closure. Patients were covered with a broad spectrum antibiotic iv.

Results Between 5- 2018 and 11- 2019 6 patients (m:3; 3-79 y) experienced acute esophageal perforation, all treated with EVT. One 3 year old child with strictures four weeks after caustic ingestion emerged a 20 mm perforation in the middle esophagus during endoscopic dilatation therapy. In 3 patients (73 y, 78 y, 79 y) acute perforation occurred after endoscopic pneumatic balloon dilatation (30 mm, Rigiflex) for achalasia at the distal esophagus (30- 50mm). The other two perforations were located in the proximal esophagus. One patient (67 y) with esophageal involvement of pemphigus vulgaris emerged perforation (40 mm) during initial endoscopic esophageal intubation. A 25 year old man showed a 20 mm perforation directly below the upper esophageal sphincter after alcoholized ingestion of a broken piece of glass.

Mean number of sponge exchanges needed were 2.8 (1-5) with a mean duration of EVT therapy of 10.2 days (4-21). After endoscopic diagnosis of closure patients started to drink and gradual returned to solid food under clinical control. EVT resulted in complete closure of the acute esophageal perforation in all 6 patients.

Conclusions Endoscopic vacuum therapy is able to close acute esophageal perforation within 1 to 3 weeks. In our case series intraluminal positioning of the sponge was sufficient. Immediate start of EVT to prevent abscess formation and induce defect closure is crucial.