Fluoroscopy-guided endoscopic vacuum therapy: An accessible and reproducible alternative for the treatment of esophageal leaks in children

• Fluoroscopy-guided endoscopic vacuum therapy (F-EVAC) was applied in 12 cases of esophageal fistulas, achieving 100% closure. • The technique uses low-cost, widely available materials and uses only fluoroscopy to insert the device, increasing accessibility in resource-limited settings. • Procedures were safe and required short treatment duration with 1 to 2 device revisions. • F-EVAC expands therapeutic options in pediatric surgery, offering an effective alternative to stents and commercial vacuum systems. Post-surgical esophageal leaks represent a significant clinical challenge, especially in children undergoing repair of esophageal atresia. Endoscopic vacuum therapy (EVAC) has emerged as an effective minimally invasive alternative for leak closure. Fluoroscopic-guided Endoscopic Vacuum Therapy (F-EVAC) consists in a technical adaptation of traditional EVAC using widely available and low-cost materials and positioned exclusively using fluoroscopy, providing an accessible and reproducible approach for managing these complications. A retrospective review was conducted at a tertiary pediatric hospital in southern Brazil, including 12 F-EVAC cases performed in 10 different children with esophagopleural fistulas following esophageal procedure. Treatment parameters, outcomes, and complications were analyzed. The mean treatment duration was 9 days, with 1–2 device revisions required. Complete leak closure was achieved in all patients, with no procedure-related complications. Follow-up ranged from 3 months to 4 years. Late complications requiring re-intervention included esophageal stricture and airway fistula. F-EVAC proved to be effective, safe, and cost-efficient, with success rates comparable to those reported for commercial devices. Its simplified execution supports applicability in resource-limited settings. Nevertheless, further studies are needed to confirm long-term efficacy and better assess potential F-EVAC related complications. This technique represents a promising alternative for the treatment of esophageal leaks following esophageal surgery in children, expanding the therapeutic options available for pediatric surgeons.