Endoscopic management of complications—endovacuum for management of anastomotic leakages: a narrative review

: Anastomotic leakages after esophagectomy are common, yet threatening complications. Possible leakage therapy ranges from reoperation to interventional treatments like stent placement or endoscopic vacuum therapy (EVAC) supported by optimized conservative therapy, ideally at an intensive care unit. Since reoperation is concomitant with high mortality, conservative and interventional therapies are applied on a frequent basis nowadays. Apart from the well-established endoscopic placement of a self-expanding-metal stent (SEMS), the EVAC has been successfully implemented in many centers in recent years. Using the same principles as subcutaneous vacuum therapy, it offers many advantages such as simultaneous drainage therapy and faster healing process. The healing process is supported by controlling the infection of the wound, promoting macro- and microdeformation of the adjacent tissue, and improvement of perfusion. Still, clear evidence about superiority of one interventional therapy strategy—either SEMS or EVAC—is lacking. This article describes the principle and the procedure of EVAC for anastomotic leakages. Current literature regarding efficiency, safety, and possible costs in comparison to SEMS therapy is reviewed. Considering the advantages EVAC therapy is offering, its value for anastomotic leakage therapy is clear. However, to reach standardized clinical application, additional research to improve the applicability and economic efficiency should be conducted.