Endoscopic vacuum-assisted closure as a first-line treatment for post-esophagectomy anastomotic leaks: A paradigm shift in management

Table 1 Studies comparing endoscopic vacuum therapy to other treatment modalities of anastomotic leakage after esophagectomy

Ref.	Study design	Patients	Success rate	Key findings
Brangewitz et al[24]	Retrospective	71 (32 EndoVAC, 39 SEMS)	Closure rate: 84.4% (EndoVAC) vs 53.8% (SEMS)	Closure rate was higher in the EndoVAC group
Schniewind et al[22]	Retrospective	62 (17 EndoVAC, 12 SEMS, 18 surgeries, 15 conservative)	Mortality: 12% (EndoVAC) vs 50% (surgery) vs 83% (SEMS)	EVT patients had lower mortality compared to surgically treated cases and SEMS
Mennigen et al[21]	Retrospective	45 (15 EndoVAC, 30 SEMS)	Closure rate: 93.3% (EndoVAC) vs 63.3% (SEMS)	Success rate was higher for EndoVAC
Berlth el al[23]	Retrospective	111 (35 EndoVAC, 76 SEMS)	Closure rate: 85.7% (EndoVAC) vs 72.4% (SEMS)	EndoVAC and SEMS show comparable results
El-Sourani et al[25]	Retrospective	28 (13 EndoVAC, 7 SEMS, 4 surgery, 1 hemoclip, 3 conservative)	Closure rate: 92.3 (EndoVAC) vs 85.7% (SEMS)	EndoVAC can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should be limited to clinically stable patients with a small defect size

EndoVAC: Endoscopic vacuum therapy; SEMS: Self-expanding metal stent; EVT: Endoscopic vacuum therapy.