190 Where Does Endoscopic Vacuum Therapy (EVT) Fit in the Perforation Severity Score (PSS) for Oesophageal Perforation?

Abstract Aim In 2019, Schweigert et al. validated the Perforation Severity Score (PSS) for oesophageal perforation and proposed a risk-stratified treatment algorithm. Endoscopic Vacuum Therapy (EVT) was not included, likely reflecting its limited adoption at the time. This study evaluates the role of EVT in managing oesophageal perforation and its potential integration into future treatment algorithms. Method A retrospective review was conducted of all patients referred with any oesophageal perforation at our tertiary UGI unit between January 2019 and May 2025. Data collected included demographics, LOS, PSS, treatment modality, and clinical outcomes. Results Sixty-two patients were included (median age 43 years; IQR 23.5-72.5), with a modal ASA score of 2 at presentation. Initial management was conservative in 60% for small, contained perforations, while intervention was carried out for uncontained perforations (EVT-15%, surgery-24%, and stenting-2%). EVT was undertaken in one patient from the low-risk group, four from the intermediate-risk group, and four from the high-risk group based on PSS stratification. Median LOS was significantly longer in the EVT and surgical groups versus conservative (p < 0.001), with no significant difference between surgery and EVT (p = 0.138). In-hospital mortality was 0% for conservative, 22.2% for EVT, and 40% for surgery. A similar distribution was noted for morbidity, with complication rates of 18.9%, 77.8%, and 93.3%, respectively. Conclusions EVT demonstrated better outcomes compared to those undergoing surgery. It serves as a viable therapeutic option and warrants consideration for integration into future revisions of risk-stratified treatment pathways, particularly for patients with uncontrolled oesophageal rupture or unsuitable for surgical treatment.