PMID- 34466361
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210903
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 9
IP  - 9
DP  - 2021 Sep
TI  - Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal 
      defects: Systematic review and meta-analysis.
PG  - E1371-E1380
LID - 10.1055/a-1508-5947 [doi]
AB  - Background and study aims  Esophageal defects (leaks, fistulas, and perforations) 
      are associated with significant morbidity and mortality. Endoluminal 
      vacuum-assisted closure (EVAC) is a novel intervention that entails the use of 
      sponges in the defect along with negative pressure to achieve granulation tissue 
      formation and healing and has been gaining popularity. We performed a systematic 
      review and pooled analysis of available literature to assess the safety and 
      effectiveness of EVAC for esophageal defects. Patients and methods  We queried 
      PubMed/Medline, Embase, Cochrane, and Web of Science through September 25, 2020 
      to include all pertinent articles highlighting the safety and effectiveness 
      profile of EVAC for esophageal defects. Pooled rates, 95 % confidence intervals 
      (CIs), and heterogeneity ( I (2) ) were assessed for each outcome. Results  A 
      total of 18 studies with 423 patients were included (mean age 64.3 years and 
      males 74.4 %). The technical success for EVAC was 97.1 % (CI: 95.4 %-98.7 %, I 
      (2)  = 0 %). The clinical success was 89.4 % (CI: 85.6 %-93.1 %, I (2) 
       = 36.8 %). The overall all-cause mortality and adverse events (AEs) noted were 
      7.1 % (CI: 4.7 %-9.5 %, I (2)  = 0 %) and 13.6 % (CI: 8.0 %-19.1 %, I (2) 
       = 68.9 %), respectively. The pooled need for adjuvant therapy was 15.7 % (CI: 
      9.8 %-21.6 %, I (2)  = 71.1 %). Conclusions  This systematic review and 
      meta-analysis showed high rates of technical success, clinical success, and low 
      all-cause mortality and AEs using EVAC. Although the technique is a promising 
      alternative, the lack of comparative studies poses a challenge in making definite 
      conclusions regarding use of EVAC compared to other endoscopic modalities, such 
      as clips and stents.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commercial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Aziz, Muhammad
AU  - Aziz M
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, 
      United States.
FAU - Haghbin, Hossein
AU  - Haghbin H
AD  - Department of Internal Medicine, University of Toledo, Toledo, Ohio, United 
      States.
FAU - Sharma, Sachit
AU  - Sharma S
AD  - Department of Internal Medicine, Promedica Toledo Hospital, Toledo, Ohio, United 
      States.
FAU - Weissman, Simcha
AU  - Weissman S
AD  - Department of Internal Medicine, Hackensack Meridian Health Palisades Medical 
      Center, North Bergen, New Jersey, United States.
FAU - Saleem, Saad
AU  - Saleem S
AD  - Department of Internal Medicine, Sunrise Hospital and Medical center, Las Vegas, 
      Nevada, United States.
FAU - Lee-Smith, Wade
AU  - Lee-Smith W
AD  - Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, United 
      States.
FAU - Kobeissy, Abdallah
AU  - Kobeissy A
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, 
      United States.
FAU - Nawras, Ali
AU  - Nawras A
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, 
      United States.
FAU - Alastal, Yaseen
AU  - Alastal Y
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, 
      United States.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210816
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC8367451
COIS- Competing interests The authors declare that they have no conflict of interest.
EDAT- 2021/09/02 06:00
MHDA- 2021/09/02 06:01
PMCR- 2021/08/01
CRDT- 2021/09/01 07:24
PHST- 2021/01/25 00:00 [received]
PHST- 2021/05/05 00:00 [accepted]
PHST- 2021/09/01 07:24 [entrez]
PHST- 2021/09/02 06:00 [pubmed]
PHST- 2021/09/02 06:01 [medline]
PHST- 2021/08/01 00:00 [pmc-release]
AID - 10.1055/a-1508-5947 [doi]
PST - epublish
SO  - Endosc Int Open. 2021 Aug 16;9(9):E1371-E1380. doi: 10.1055/a-1508-5947. 
      eCollection 2021 Sep.