193 Endoluminal Vacuum Therapy (EVT) as a Gold Standard for Upper Gastrointestinal Perforations: A 13 Year Experience in a Tertiary Referral Centre

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Abstract Background There are around 2,800 oesophageal perforations and leaks in the UK each year, with mortality reaching 50% when diagnosis and subsequent treatment is delayed. Management traditionally involved high-risk invasive surgery with prolonged ITU stays. Over the last 13 years our unit, a tertiary referral centre, has adopted EVT as first-line management for these cases, using an ad-hoc Endoluminal Vacuum Device (EVD). Aims and Methods Our primary aim was to assess the successful perforation/ leak healing rate, overall mortality and complication rate of EVT. Retrospective analysis of a prospectively collated database for all patients who received EVT between May 2011 and October 2024 was performed. Oesophageal, gastric and duodenal perforations were included. Results 108 patients received EVT, median age was 65 years (range 23-92years), median ASA was 3 (range 1-5). M:F=59:49. 87 cases were oesophageal, 17 gastric and 4 duodenal. 45 patients had a post-operative leak, 30 perforations were spontaneous, 27 iatrogenic and 6 traumatic. Leak resolution was achieved in 98 (90.7%) patients. 12 (11.1%) patients died, 7 (6.5%) of which were due to primary treatment failure. 4 (3.7%) significant bleeding events occurred directly related to the leak as a result of undrained sepsis. Conclusion EVT is safe and effective in the management of upper GI leaks irrespective of aetiology. Our unit has achieved a significant reduction in mortality when compared to traditional management. It should be considered for first-line management in patients with a delayed presentation of oesophageal perforation, following anastomotic leaks and select gastric and duodenal perforations.

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