303. VACUUM-STENT TREATMENT FOR TRANSMURAL DEFECTS IN THE UPPER GASTRO-INTESTINAL TRACT: CASE SERIES AND NEW INSIGHTS IN A TERTIARY REFERRAL CENTER

Abstract Background Transmural defects in the upper gastro-intestinal (GI) tract are associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has recently been established as promising endoscopic treatment option for such defects and is most often applied using endoscopically placed vacuum-sponges. The vacuum-stent is a novel device to apply EVT, combining the advantages of negative pressure wound therapy and an intraluminal stent, allowing for oral intake. Methods The aim of this prospective cohort study is to describe the experiences of, and lessons learned by a tertiary referral center with EVT experience since 2018, regarding the vacuum-stent for transmural defects in the upper GI tract. All patients treated with a vacuum-stent between November 2022 and October 2023 were included. Outcome measures included successful defect closure, reasons of treatment failure, adverse events and strictures. Results 31 patients were included. Baseline characteristics and outcomes are displayed in Table 1. Success rates of combined vacuum-stent and –sponge treatment and vacuum-stent treatment alone were respectively 83% and 78%. In this cohort, some notable reasons of failure were observed: a defect too close to the upper esophageal sphincter (UES), inadequate vacuum on the esophago-jejunal anastomosis, a carcinoma at a persisting perforated ulcer, and adverse events. Two adverse events occurred (6%): two patients developed a secondary defect at the site of the proximal vacuum-stent flange, of whom one had a cervical anastomosis with a narrow proximal esophagus and one Boerhaave syndrome. Three out of four patients with a severe structure had underwent a McKeown esophagectomy. Conclusion The vacuum-stent is a valuable treatment option for AL after Ivor Lewis esophagectomy, Boerhaave syndrome and iatrogenic defects with success rates of 78-83%. Treating cervical anastomotic leaks is not recommended by us, due to the narrow lumen of the proximal esophagus, the proximity of the UES and high risk of severe strictures. Furthermore, caution is recommended in case of a narrow esophagus. In our experience, vacuum-stent and –sponge treatment complement each other and might be indicated in different situations. Sharing experiences on the topic is important to assess the best techniques and indications, to be able to reach the full potential of the vacuum-stent and further increase the success rate.