816 posters, 24 topics, 3,314 authors, 1,012 institutions

SAGES 2026 Annual Meeting Emerging Technology Session

March 25-28, 2026 | Tampa, FL, USA

P558

Endoluminal Vacuum Therapy for the Management of Esophageal Leaks and Perforations

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Poster Presenter

Saamia Shaikh

Authors

Saamia Shaikh, Kristen R Kent, McKell Quattrone, Eric D Moyer, Skylar Korek, Vamsi V Alli, Elizabeth M Sodomin, Eric M Pauli, Joshua S Winder

Affiliations

Penn State Health Milton S. Hershey Medical Center, Hershey, PA, Endeavor Health, Evanston, IL

Part of Topic

Flexible Endoscopy

ENDOLUMINAL VACUUM THERAPY FOR THE MANAGEMENT OF ESOPHAGEAL LEAKS AND PERFORATIONS

Saamia Shaikh, DO JD¹, Kristen R. Kent, MD MPhil¹, McKell Quattrone, MD¹, Eric D. Moyer, MD¹, Skylar Korek, MD¹, Vamsi V. Alli, MD², Elizabeth M. Sodomin, MD¹, Eric M. Pauli, MD¹, Joshua S. Winder, MD¹

1.Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA

2. Department of Surgery, Endeavor Health, Evanston, IL

BACKGROUND

Esophageal leaks and perforations can be life-threatening and were traditionally managed surgically with either primary repair, esophageal diversion, or complex delayed conduit reconstruction and are associated with high morbidity and mortality.

Endoluminal vacuum therapy (eVAC) is a minimally invasive endoscopic approach that has revolutionized the management of leaks throughout the gastrointestinal tract.

METHODS

Single institution retrospective review of patients with esophageal injuries undergoing eVAC therapy by a surgical endoscopist

Clinical success defined as endoscopic findings revealing a closure of the esophageal defect or a healing abscess cavity with granulation tissue.

RESULTS

16 patients identified (2017–2025)

3 excluded: pediatric (n=1), aortoesophageal fistula (n=1), abdominal esophageal leak (n=1)

Final cohort: 13 patients

Indications for eVAC:

Esophagojejunal anastomotic dehiscence – 46% (n=6)

Esophagogastric anastomotic dehiscence – 31% (n=4)

Esophageal perforation – 15% (n=2)

Staple-line breakdown – 8% (n=1)

Patient Characteristics:

Median age: 63 years

Male: 62%

White: 86%

Mean BMI: 30.5 kg/m²

eVAC Therapy Outcomes:

Mean therapy duration: 37.9 days (4–137)

Mean exchanges: 11 (2–41)

Mean hospital LOS: 50 days

Mean time to oral intake: 46.8 days

Technical success: 100%

Clinical success: 69%

Adjunct Interventions

Additional endoscopic therapy: 38

Esophageal stent

Double pigtail stent

Over-the-scope clip

Complications:

Post-therapy fistula requiring intervention: 2 patients

Stricture requiring dilation/stent: 1

Hemorrhage after lytic therapy: 1

Mortality: 15%

CONCLUSIONS

eVAC therapy is technically feasible and achieves defect closure in most patients with esophageal leaks or perforations.

Despite the need for frequent adjunctive therapies and prolonged hospitalizations, eVACs are an effective therapeutic approach for esophageal transmural defects and avoids the morbidity of revisional or damage control surgery.