• anastomotic leak
• endoscopic vacuum therapy
• practical review
• upper gastrointestinal tract

There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches. We conducted a systematic review of case reports documenting Boerhaave syndrome.

To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.

We searched PubMed, Google scholar, MEDLINE, and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.

Of the included studies, 49 were case reports, including a total of 56 cases. The mean age was 55.8 ± 16 years old. Initial conservative treatment was performed in 25 cases, while operation was performed in 31 cases. The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission (9.7% vs 44.0%; P = 0.005). Seventeen out of 25 conservative cases (68.0%) were initially treated endoscopic esophageal stenting; 2 of those 17 cases subsequently underwent operation due to poor infection control. Twelve cases developed postoperative leakage (38.7%), and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage. The length of the hospital stay was not significantly different between the conservative treatment and operation cases (operation vs conservation: 33.52 ± 22.69 vs 38.81 ± 35.28 days; P = 0.553).

In the treatment of Boerhaave syndrome, it is most important to diagnose the issue immediately. Primary repair with reinforcement is the gold-standard procedure. The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.

• Boerhaave syndrome
• Esophageal perforation
• Self expandable metalic stent
• Minimally invasive surgical procedures
• Anastomotic leakage
• Shock

• Esophageal perforation
• incidence
• prognosis
• survival

Eso-SPONGE® has proved to be an excellent method for the treatment of persistent dehiscence of the intrathoracic esophagogastric anastomosis during the operation of subtotal esophagectomy sec. Ivor Lewis.

The case presented is of a 72-year-old patient with esophageal adenocarcinoma (ADK) who underwent sub-total esophagectomy and esophagoplasty sec. Ivor Lewis complicated by an esophageal leak. The Eso-SPONGE® therapy has been successful halving the index of inflammation after the first two sessions and generation of a neowall after seven sessions.

Eso-SPONGE® therapy has proven to be a valuable resource as a treatment for esophageal anastomotic dehiscences because it is easily repeatable in suburban centers, provided that they have a digestive endoscopy specialized in the positioning process.

Eso-SPONGE® is a minimally invasive method that delivers excellent results in the treatment of fragile patients, such as those who have post-esophageal anastomotic dehiscence.

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Anastomotic dehiscence is an adverse event in esophageal surgery.

• Eso-SPONGE®
• Esophageal anastomosis
• Esophageal dehiscence case report
• Esophagectomy
• Ivor-Lewis's technique
• Surgery of esophagus

• endoscopic vacuum therapy
• etiology
• transmural defect
• upper gastrointestinal tract

• Esosponge
• esophageal leak
• esophagectomy
• vacuum therapy

Acute, high-grade esophageal perforation and postoperative leak after esophagogastrostomy are associated with high morbidity and mortality due to the development of mediastinitis and thoracic contamination. Endoscopic vacuum therapy has proven to be a feasible, safe therapy for management of esophageal wall defects, but with limited success. We describe a retrospective single-center analysis of two patients who underwent endoscopic vacuum therapy for significant esophageal disruptions with a median cross-sectional diameter of 10.7 cm. The technique involved the use of a standard upper video endoscope, nasogastric tube, and vacuum-assisted closure dressing kit, with endoscopic placement of a polyurethane sponge and nasogastric tube assembly into the mediastinal or thoracic cavity. Serial washout and debridement were performed prior to each sponge insertion. Data were collected on indication, size of the cavities, time to intervention, number of procedures, time to resolution, outcomes, and adverse events. Two patients underwent therapy with a mean age of 69.5. The median size of the collections via longest cross-sectional diameter was 10.7 cm. The average number of endoscopic vacuum therapy performed was six and average duration of therapy was 49 days. Complete resolution was achieved in both patients. One patient died 6 weeks later due to severe sepsis from aspiration pneumonia. Endoscopic washout and debridement followed by endoscopic vacuum therapy can be effective for large, even multiple, thoracic and mediastinal contaminations following esophageal perforation and gastroesopagheal anastomotic dehiscence and leaks in appropriately selected patients.

• anastomotic leak
• endoscopic vacuum therapy
• esophageal disruption
• esophageal perforation