The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Safety and Effectiveness of Endoluminal Vacuum-Assisted 
Closure for Esophageal Defects: Systematic Review and 
Meta-Analysis 
Muhammad Aziz 1*, Hossein Haghbin1, Sachit Sharma2, Simcha Weissman1, 
Saad Saleem1, Wade Lee-Smith3, Abdallah Kobeissy1, Ali Nawras1, Yaseen 
Alastal1

1Division of Gastorenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 
2Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
3Department of University Libraries, The University of Toledo, Toledo, OH 43614 

*Corresponding author: Muhammad.Aziz@utoledo.edu

Published: 05 May 2023 

Background: 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. 

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 (I2) 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 %).  

Conclusion: 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. 

https://dx.doi.org/10.46570/utjms.vol11-2023-675 

https://dx.doi.org/10.46570/utjms.vol11-2023-675
mailto:Muhammad.Aziz@utoledo.edu