Yazan Fahmawi, MD1, Faris Hammad, MD2, Yousef Abdel-Aziz, MD, MPH3, Sami Ghazaleh, MD4, Lindsey Merritt, DO1, Meir Mizrahi, MD1, Tariq Hammad, MD5; 1University of South Alabama, Mobile, AL; 2Saint Vincent Hospital, Cleveland, OH; 3University of Tennessee Health Science Center, Memphis, TN; 4University of Toledo Medical Center, Toledo, OH; 5West Virginia University, School of Medicine, Bridgeport, WV
Introduction: Esophageal perforation is a serious disease with high morbidity and mortality rates. It is most commonly iatrogenic. Traditionally, surgical exploration and endoscopic interventions such as clipping, stent placement have been the primary methods for management. However, these interventions carry high adverse events and failure rates. Endoscopic vacuum therapy (EVT) has been introduced as a new endoscopic modality for management of anastomotic leakages after esophagectomy. EVT involves endoscopic insertion of polyurethane sponges into the esophageal lumen or into the cavity and the trans nasal application of external vacuum. More recently, EVT has been used as a new treatment option for esophageal perforation. In this meta-analysis study, we aim to assess the efficacy and safety of EVT for the management of esophageal perforation. Methods: MEDLINE, Scopus, and Cochrane Library databases were searched from inception until January 2020 for studies reporting the clinical success and adverse events rates of EVT for esophageal perforation. Studies with < 5 patients were excluded. Clinical success was defined as a complete healing of the perforation. Heterogeneity was assessed using I2. Depending on the heterogeneity, pooled estimates and the 95% confidence interval (CI) were calculated using either random-effect or fixed-effect models Results: Eight studies (6 retrospective and 2 prospective) involving 103 patients were included. The etiology of esophageal perforation was iatrogenic in 73.3% of cases, spontaneous in 23.7%, and secondary to foreign body in 3%. The pooled overall clinical success rate was 94.2% (95%CI: 89.9-98.5%, I2= 5.6%) (Figure 1). The pooled clinical success rate for iatrogenic perforation was 92.4% (95%CI: 84.4-97.1%, I2= 9.3%) whereas the pooled clinical success rate for spontaneous perforation was 90.1% (95%CI: 73.2-98%, I2=0%). The pooled adverse events rate was 8% (95%CI: 0.3- 16.2%, I2= 71.4%). Mediastinal emphysema was the most common complication. Stent placement was required in 5.2% of the cases. Conversion to surgical treatment was required in 5.2% of the cases as well. No EVT-related mortality were reported. Discussion: EVT seems to be an effective as well as safe intervention for esophageal perforation. Further larger prospective studies are warranted.
Figure 1: Forrest Plot for Clinical Success Rate
Disclosures: Yazan Fahmawi indicated no relevant financial relationships. Faris Hammad indicated no relevant financial relationships. Yousef Abdel-Aziz indicated no relevant financial relationships. Sami Ghazaleh indicated no relevant financial relationships. Lindsey Merritt indicated no relevant financial relationships. Meir Mizrahi indicated no relevant financial relationships. Tariq Hammad indicated no relevant financial relationships.