S5288 Positive Outcomes With Endoscopic Vacuum-Assisted Closure (EndoVAC) Therapy for Proximal Gastrointestinal Perforations and Mediastinal Leaks: A 5-Case Series

Introduction: Endoscopic vacuum-assisted closure (EndoVAC) therapy is a minimally invasive approach that promotes efficient healing and defect closure in the setting of proximal gastrointestinal (GI) tract perforation and mediastinal leaks. Negative pressure facilitates secretion drainage, reduces edema, and promotes granulation tissue formation. We present 5 cases of proximal GI tract perforation successfully managed with EndoVAC, demonstrating its efficacy as both primary and salvage treatment. Case Description: We retrospectively reviewed 5 patients with proximal GI tract perforations and associated mediastinal leaks stemming from various etiologies including spontaneous ruptures, iatrogenic causes and anastomotic leaks. All cases were treated with EndoVAC, requiring sequential EndoVAC sponge exchanges and negative pressure therapy. Successful defect closure and leak resolution was observed in all 5 cases, confirmed by endoscopy and upper GI series. In the first case, patient presented with a spontaneous esophageal perforation in the setting of a large hiatal hernia. Robotic-assisted repair with mediastinal drainage failed due to re-perforation. EndoVAC therapy was successful, requiring 5 EndoVAC exchanges over 32 days. In the second case, patient underwent EsoFLIP dilation for achalasia, complicated by iatrogenic perforation, for which initial closure with endoscopic stenting and suturing failed. Esophageal defect was successfully managed with EndoVAC, requiring 2 exchanges over 11 days. In the third case, patient presented with a post-esophagectomy anastomotic leak, requiring 5 EndoVAC exchanges over 35 days. In the fourth case, patient presented with a leak from mesh erosion after revisional hiatal hernia repair, requiring 4 EndoVAC exchanges over 21 days with assistance from Ovesco closure. In the fifth case, the patient demonstrated a gastrojejunal leak post–Roux-en-Y Gastric Bypass, requiring 7 EndoVAC exchanges over 51 days. Mean treatment duration was 30.6 days (range: 11-51), with a mean of 4.6 exchanges (range: 2-7). No EndoVAC-related complications were observed. Discussion: This case series highlights successful defect closure and leak resolution across a range of challenging clinical scenarios, including failed surgical and endoscopic interventions. Therefore, EndoVAC therapy offers a reliable approach for managing complex proximal GI tract perforations and mediastinal leaks and can be strongly considered as an early treatment option for primary and refractory cases.