VACStent: a new option for endoscopic vacuum therapy in patients with esophageal anastomotic leaks after upper gastrointestinal surgery

Esophageal anastomotic leaks remain a life-threatening postoperative complication of upper gastrointestinal surgery. In Germany, self-expandable metal stents (SEMS) and endoscopic vacuum therapy (EVT) are established endoscopic treatment options [ 1 ] [ 2 ], but no evidence points to the superiority of either of these [ 3 ]. Consequently, new approaches aim to combine both procedures [ 4 ] [ 5 ]. One available medical device that combines EVT (sealing and drainage) with SEMS treatment (sealing and food passage) is a fully covered SEMS coated with a polyurethane foam (VACStent; Möller Medical GmbH, Fulda, Germany) ([ Fig. 1 ]). To our knowledge, this is the first report on using a hybrid SEMS for treating an esophageal anastomotic leak ([ Video 1 ]). Fig. 1 VACStent: a fully covered, self-expandable metal stent (dimension 30 × 15 × 70 mm) coated with polyurethane foam and connected to a tube (blue). Video 1 Successful treatment of an esophageal anastomotic leak after gastrectomy with a novel hybrid stent. Quality: mobile 360 480 720 Download A 61-year-old man with an esophageal anastomotic leak ([ Fig. 2 ]) had undergone previous total gastrectomy for a signet cell carcinoma of the stomach. On the 16th postoperative day (POD), the patient was admitted to our hospital in a septic condition, having been treated unsuccessfully with an over-the-scope clip (Ovesco Endoscopy AG, Tübingen, Germany). We performed an endoscopy (POD 16) and discovered a semicircular anastomotic leak of the esophagojejunostomy with an abscess cavity. We removed the clip and applied a VACStent (125 mmHg negative pressure) to treat the leak. A computed tomography scan with oral contrast ([ Fig. 3 ]) confirmed sealing of the leak so that oral intake of fluids was possible. Fig. 2 View of the esophagojejunal anastomosis: jejunum (blue asterisk) and anastomotic leak area (yellow arrow). Fig. 3 Axial computed tomography with oral contrast showed complete sealing of the leak by the VACStent (yellow arrow) with a thoracic drain (asterisk). The following endoscopy (POD 18) demonstrated a healing tendency; consequently, we placed a second VACStent. After VACStent removal (POD 22), we observed a sealed leak with a small and encapsulated wound cavity ([ Fig. 4 ]). A digestive swallowing test confirmed the sealing. Although the postoperative course was delayed because of pulmonary complications, the patient was discharged (POD 39) ([ Fig. 5 ]) with full oral intake and no clinical signs of a residual anastomotic leak. Fig. 4 The sealed leak of the esophagojejunal anastomosis: blind loop jejunum (black asterisk), jejunum (yellow asterisk), and granulation of the wound cavity (red asterisk). Fig. 5 Follow-up endoscopy 17 days after VACStent explantation. Endoscopy_UCTN_Code_TTT_1AO_2AI Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos