Endoscopic vacuum therapy – when and how to use it?

Background: Gastrointestinal (GI) transmural defects are potential life-threatening conditions that need timely diagnosis and multi-modality treatment. Currently, there is a wide spectrum of minimally invasive therapeutic options that can be used alone or in combination. Recently, endoscopic vacuum therapy (EVT) has been added to these endoscopic therapeutic options. Summary: EVT has been showing promising clinical success rates with an acceptable safety profile competing with endoscopic stents. Due to its capacity to control exudate and to create granulation tissue, EVT is probably the best treatment for large size or chronic defects, or those associated with large collections. Nevertheless, there is lack of evidence about the best approach for each type of defect. The treatment course should be selected considering clinical status, type of surgery, chronicity, location and size of the defect, associated infected tissue and local expertise. Despite its therapeutic potential, new devices and technical improvements are needed to standardize the technique, overcome EVT-related technical difficulties and reduce complications.