Endoscopic vacuum-assisted closure as a first-line treatment for post-esophagectomy anastomotic leaks: A paradigm shift in management

Post-esophagectomy anastomotic leak (AL) is a severe complication following esophagectomy, contributing to increased morbidity, prolonged hospitalization, and a significant risk of mortality. Endoscopic vacuum-assisted closure (EndoVac) has emerged as a promising first-line treatment, offering a highly effective approach for managing post-esophagectomy AL. EndoVac therapy utilizes continuous negative pressure within the esophageal lumen or mediastinal cavity, promoting granulation tissue formation, accelerating wound healing, and enhancing AL closure rates. Compared to stenting, EndoVac provides distinct advantages, including superior adaptability to varying leak sizes and locations, enhanced secretion drainage, and lower rates of reintervention. Clinical studies have demonstrated higher success rates, decreased post-intervention complications, and shorter hospital stays. Despite its advantages, challenges persist in patient selection, procedural expertise, and accessibility. EndoVac application requires experienced endoscopic teams and multidisciplinary expertise, which is best achieved in high-volume centers with specialized care. Variability in EndoVac protocols necessitate further refinement and standardization to optimize treatment outcomes. The integration of EndoVac into standardized treatment guidelines holds promise for improving patient outcomes and redefining the management approach for this challenging postoperative complication.