Endoscopic vacuum therapy for Boerhaave’s syndrome—a single tertiary referral center retrospective cohort analysis with a treatment algorithm

Summary Background Boerhaave’s syndrome (BS) is a rare but often fatal condition with high mortality rates despite intensive treatment. Data are scarce. We herein report a single-center experience with BS. The aim of this study was to investigate and point out the role of endoluminal vacuum therapy (EVT) in BS. Methods Between June 2011 and April 2024, all patients with BS in our tertiary referral center with a unit specialized in surgical endoscopy were analyzed regarding age, gender, delay of diagnosis, treatment technique, and outcome. Results During the study period, 12 consecutive patients (9 male) were treated for BS. The median age was 64.8 years. Five patients were treated with EVT only, four with surgery and simultaneous EVT, and three by surgery only. After implementation of EVT, all patients were treated with either EVT only or surgery with simultaneous EVT. Intensive care unit stay was significantly shorter in patients treated with EVT only. The 30-day mortality was 25% (3 patients). No long-term complications occurred. Conclusion This investigation led to our current strategy of applying only EVT in patients in a stable condition and no CT signs of vast pleural content. Otherwise, surgery plus EVT is performed.