VACStent closure of oesophageal defects by covered stent and endoscopic vacuum therapy: initial use and clinical outcomes

Endoscopic management of transmural oesophageal defects following esophagectomy or spontaneous perforations, such as Boerhaave's syndrome, is often complicated by stent migration and luminal occlusion [1]. The Vacuum-Assisted Closure (VAC) stent, which integrates a covered stent with endoscopic vacuum therapy, aims to address these issues by providing functional drainage and promoting wound healing [2]. This case series presents our initial experience with VACStent therapy in four patients treated between February 2023 and April 2024. Two patients had staple line defects post-esophagectomy, and two had Boerhaave's syndrome. Treatment involved stent placement under general anaesthesia, followed by evaluations and scheduled stent exchanges every 6 days. All patients achieved successful defect closure, with no procedural complications noted. Three patients required one stent application, while one needed two applications. VACStent therapy appears to be a safe and effective treatment for transmural oesophageal defects, potentially establishing a new standard of care.

272 Effectiveness of Intraoperative Botulinum Toxin Injection on Gastric Emptying During Oesophagectomy: A Systematic Review

Introduction

Oesophagectomy is the standard of care for resectable oesophageal carcinoma and remains pivotal for curative treatment. Pull-up with gastric conduit remains the most common reconstruction. Delayed gastric emptying (DGE) is a recognised complication and may lead to delayed postoperative recovery and prolonged hospital stay. Botulinum Toxin BTA has been used to relax the hypertonic pylorus intraoperatively and improve DGE. The aim of this review was to assess the efficacy of intraoperative BTA on gastric emptying and the need for postoperative endoscopic pyloric intervention (EPI).

Method

Systematic review of literature was conducted using electronic database searched up to October 2020 including Cochrane Library, Medline, Embase and Goggle Scholars to identify relevant studies. Data was extracted and critically appraised by two independent authors.

Results

Eleven studies were included for systematic review with 1800 patients assigned to either BTA, pyloroplasty, pyloromyotomy, or no-intervention. Ten were observational studies and one was a randomised experimental study. Only one study reported a statistically significant benefit of BTA on early DGE (Day 4, 59%, P < 0.001). Three studies reported higher rates of postoperative EPI when chemical pyloroplasty was used. Length of Hospital stay was higher for patients who had BTA compared to other techniques in three studies.

Conclusions

This systematic review did not demonstrate any significant benefit of intraoperative BTA on gastric emptying on the long term. The rate of endoscopic pyloric intervention was higher in these patients as reported by some studies. Further studies are required to investigate the outcome of chemical pyloroplasty during esophagectomy.