Percutaneous Endoscopic Vacuum Therapy for Patients With Postoperative Enterocutaneous Fistulas: A Retrospective Study

Background and Aims: Enterocutaneous fistulas following intestinal surgery are a feared complication with high morbidity and mortality.The therapeutic management of these fistulas is challenging.Percutaneous endoscopic vacuum therapy may be a new promising approach.Therefore, we aimed to evaluate the feasibility, effectiveness, and safety of percutaneous endoscopic vacuum therapy in patients with postoperative enterocutaneous fistulas.Methods: Patients with postoperative enterocutaneous fistulas treated with percutaneous endoscopic vacuum therapy were included and analyzed retrospectively.The primary endpoint was successful fistula closure using percutaneous endoscopic vacuum therapy.Results: This study included 44 patients, with a median follow-up of 5.9 months.Most patients (n = 35/44, 79.5%) received combined endoscopic treatments.The median duration of percutaneous endoscopic therapy was 37 days (range 1-370 days), with a median of six endoscopic interventions (range 1-15).Percutaneous endoscopic vacuum therapy was successful in 30 patients (68.2%).The remaining 14 patients (31.8%) required surgical revision, and of these, 10 (71.4%) achieved complete healing postoperatively.The overall success rate was 90.1% (n = 40/44).Procedure-related complications (anastomotic stenosis and duodenal ulcer bleeding) occurred in six patients (n = 6/44; 13.6%); four were treated endoscopically, while two required re-operation.The 30-day mortality rate was 20.5% (n = 9/44), and none of the deaths were treatment-related. Conclusions:Percutaneous endoscopic vacuum therapy is feasible, effective, and safe for endoscopic treatment of postoperative enterocutaneous fistulas.Given the complexity of this severe condition, developing an individualized, multidisciplinary therapeutic concept based on clinical conditions and fistula morphology is crucial for the successful treatment.