Katsaros I, Papadakos SP, Despotidis M, Koutsoumpas A, Schizas D. Endoscopic vacuum-assisted closure as a first-line treatment for post-esophagectomy anastomotic leaks: A paradigm shift in management. World J Gastrointest Surg 2025; 17(12): 113305 [DOI: 10.4240/wjgs.v17.i12.113305]
Corresponding Author of This Article
Ioannis Katsaros, First Department of Surgery, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens 11527, Attikí, Greece. gikats.md@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Katsaros I, Papadakos SP, Despotidis M, Koutsoumpas A, Schizas D. Endoscopic vacuum-assisted closure as a first-line treatment for post-esophagectomy anastomotic leaks: A paradigm shift in management. World J Gastrointest Surg 2025; 17(12): 113305 [DOI: 10.4240/wjgs.v17.i12.113305]
World J Gastrointest Surg. Dec 27, 2025; 17(12): 113305 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.113305
Endoscopic vacuum-assisted closure as a first-line treatment for post-esophagectomy anastomotic leaks: A paradigm shift in management
Ioannis Katsaros, Stavros P Papadakos, Markos Despotidis, Andreas Koutsoumpas, Dimitrios Schizas
Ioannis Katsaros, Markos Despotidis, Dimitrios Schizas, First Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Stavros P Papadakos, Andreas Koutsoumpas, First Department of Gastroenterology, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Co-corresponding authors: Ioannis Katsaros and Dimitrios Schizas.
Author contributions: Katsaros I, Papadakos SP, and Despotidis M performed most of the writing; Koutsoumpas A and Schizas D critically reviewed the manuscript and were the supervisors of the project. All the author approval the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Katsaros, First Department of Surgery, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens 11527, Attikí, Greece. gikats.md@gmail.com
Received: August 21, 2025 Revised: September 7, 2025 Accepted: October 27, 2025 Published online: December 27, 2025 Processing time: 126 Days and 4.6 Hours
Abstract
Post-esophagectomy anastomotic leak (AL) is a severe complication following esophagectomy, contributing to increased morbidity, prolonged hospitalization, and a significant risk of mortality. Endoscopic vacuum-assisted closure (EndoVac) has emerged as a promising first-line treatment, offering a highly effective approach for managing post-esophagectomy AL. EndoVac therapy utilizes continuous negative pressure within the esophageal lumen or mediastinal cavity, promoting granulation tissue formation, accelerating wound healing, and enhancing AL closure rates. Compared to stenting, EndoVac provides distinct advantages, including superior adaptability to varying leak sizes and locations, enhanced secretion drainage, and lower rates of reintervention. Clinical studies have demonstrated higher success rates, decreased post-intervention complications, and shorter hospital stays. Despite its advantages, challenges persist in patient selection, procedural expertise, and accessibility. EndoVac application requires experienced endoscopic teams and multidisciplinary expertise, which is best achieved in high-volume centers with specialized care. Variability in EndoVac protocols necessitate further refinement and standardization to optimize treatment outcomes. The integration of EndoVac into standardized treatment guidelines holds promise for improving patient outcomes and redefining the management approach for this challenging postoperative complication.
Core Tip: Post-esophagectomy anastomotic leak is a severe complication with increased morbidity and high risk of mortality. Endoscopic vacuum-assisted closure has emerged as an effective first-line treatment for managing this condition. The therapy applies continuous negative pressure to promote granulation tissue and accelerate healing. When compared to stenting, endoscopic vacuum-assisted closure has superior adaptability, enhanced drainage, and lower reintervention rates. Clinical studies confirm higher success rates and shorter hospital stays. However, the procedure requires experienced, multidisciplinary teams, and protocols need further standardization to optimize outcomes.
