Endoscopic vacuum therapy for esophageal transmural defects

Esophageal perforations, leaks, and fistulas are potentially life-threatening due to the proximity of vital mediastinal structures such as the heart, lungs, and aorta.While small defects without systemic complications may be managed conservatively, larger defects with sepsis or abscess often require urgent intervention.Surgery is the traditional standard, but many patients are poor surgical candidates because of comorbidities or local inflammation and necrosis.Endoscopic vacuum therapy (EVT) has emerged as a safe and effective minimally invasive alternative for managing esophageal transluminal defects.By applying continuous negative pressure, EVT promotes granulation, removes secretions, and reduces bacterial load.Both intracavitary and intraluminal approaches have shown efficacy, and EVT can be used as either primary or rescue therapy for postoperative leaks or anastomotic failures.Recent studies and case series report high clinical success rates and low adverse event risks.Given its favorable safety profile and efficacy, EVT is increasingly considered a first-line option for esophageal transluminal defects, particularly in non-surgical candidates.