Keywords
Negative pressure wound therapy
Esophageal perforation
Anastomotic leak
Self-expanding metal stents
How to Cite
Abstract
Background: Upper gastrointestinal transmural defects carry mortality rates exceeding 20%. Endoscopic vacuum therapy (EVT) has emerged as a promising alternative to self-expanding metal stents (SEMS), yet optimal patient selection, timing, and technique remain uncertain.
Methods: Relevant literature was identified through a narrative search of PubMed, Embase, and Cochrane Library through January 2026. Corrected covered area (CCA) analysis quantified primary study overlap across meta-analyses comparing EVT to SEMS. This review was reported in accordance with the SANRA checklist.
Results: Five meta-analyses were identified, with all comparative evidence derived from esophageal anastomotic leak and iatrogenic perforation populations. CCA analysis demonstrated very high overlap (CCA = 95.0%), confirming convergent re-analyses of the same evidence base rather than independent replication. No randomized controlled trials have been completed. Within this low-certainty observational evidence, EVT was associated with higher defect closure rates (85% vs 64%), lower mortality (risk difference [RD] -0.12), shorter treatment duration (14-day reduction), and fewer adverse events (RD -0.24) compared with SEMS; all effect measures are EVT minus SEMS and should not be interpreted causally. Recent 2023-2025 data showed significantly fewer patient-level complications with EVT (8.3% vs 50%; P = .001). Critical predictors of failure include delayed initiation beyond 7 days, neoadjuvant chemoradiation, and intraluminal sponge placement.
Conclusions: EVT was associated with favorable outcomes compared with SEMS across convergent analyses, primarily in esophageal leak and perforation populations; these hypothesis-generating findings should not be extrapolated to other indications without dedicated evidence. Prospective randomized trials, FDA device pathway development, and standardized protocols remain priorities.
References
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Copyright (c) 2026 Rowan Bandaranaike, Benjamin Hewitt, Tyler Black, Paul Lamb, Travis Rutland