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Introduction

Oesophageal leaks and fistulae are a major complication of upper gastrointestinal surgery leading to high rates of postoperative morbidity and mortality. Self-expanding metal stents (SEMS) are the endoscopic mainstay of treatment. Recently, endoscopic vacuum therapy (EVT) as emerged as a promising alternative. The present study intends to evaluate the success rate and safety of EVT versus SEMS in upper gastrointestinal tract surgical leaks/fistulae in a referral centre.

Aims & Methods

We included all patients undergoing EVT in 2022-2023 (n=5) versus all patients submitted to SEMS from 2014 to 2022 (n=39) due to upper gastrointestinal tract surgical leak/fistulae.

Results

There were no statistically significant differences regarding distribution by gender, age, benign vs malignant disease, time from complication diagnosis to endoscopic treatment, time from surgery to endoscopic treatment and leak size (p>0.05).
The success rate, defined as complete closure of the surgical leak/fistulae, was reached in all patients submitted to EVT and in 56.4% of patients with SEMS (p=0.14). Two patients undergoing EVT were previously submitted to unsuccessful SEMS treatment. The median number of endoscopic treatment sessions were significantly superior for EVT [4 (IQR:3) vs 2 (IQR:1); p<0.01].
Technique related complications, readmission and mortality rates were superior in SEMS vs EVT (76.9% vs 0%; 51.3% vs 20%; 35.9% vs 0%, respectively), although these differences were only statistically significant for complication rate (p<0.01). None of the deaths were related to stent placement.

	EVT (n=5)	SEMS (n=39)	p value
Male gender	80%	66.7%	1
Age (IQR), in years	69 (11)	62 (17)	0.09
Charlson’s index (IQR)	4 (2)	3 (4)	0.39
Malignant disease	80%	59%	0.63
Leak size (range), in mm	15 (10-30)	11 (5-30)	0.25
Time leak diagnosis-endoscopic treatment (range), in days	5 (3-24)	12 (4-20)	0.52
Time surgery-endoscopic treatment (range), in days	27 (15-49)	15 (4-59)	0.91
Time to removal (range), in days	27 (15-49)	31 (7-56)	0.51
Admission length (range), in days	55 (37-72)	49 (2-228)	0.67

Conclusion

Although with a higher number of treatment sessions, our experience showed that EVT is a safe and effective alternative to endoscopic stenting, with higher success rate (100% vs 56.4%) and lower complication, readmission, and mortality rates. Our data shows that EVT has the potential to become the new gold standard in the endoscopic treatment of oesophageal leaks and fistulae.

ENDOSCOPIC VACUUM THERAPY VERSUS SELF-EXPANDING METAL STENTS FOR POSTOPERATIVE OESOPHAGEAL LEAKS: A CASE-CONTROL STUDY

Mara Costa 1, Andrea Silva 2, Diogo Feijó 2, Marta Gravito-Soares 3, Elisa Gravito-Soares 3, Pedro Amaro 1, Claudia Agostinho 1, Manuela Ferreira 1, Pedro Figueiredo 3

1 Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

2 Centro Hospitalar e Universitário de Coimbra

3 Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal|||Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Innovations in upper GI endoscopy (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Podcast Episode

UEG Podcast

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Physician Wellbeing

Martina Müller-Schilling, Egle Dieninyte - Misiune

Published

2024

UEG Podcast Episode

UEG Podcast

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UEG Online Courses x UEG Podcast: Impact of polyp detection in colonoscopy

Raf Bisschops, Manuele Furnari, Pieter Sinonquel, Veronique Van der Voort

Topics

Endoscopy

Published

2026

UEG Podcast Episode

New

UEG Podcast

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EoE with Alex Straumann - Part 2

Egle Dieninyte - Misiune, Alex Straumann

Topics

Oesophagus

Published

2026

UEG Standards and Guidelines

Consensus

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ABSTRACT

Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Amir Mari

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Oesophagus

Citation

United European Gastroenterol J, 13: 855-901

Published

2025

UEG Standards and Guidelines

Consensus

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ABSTRACT

This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt “fatty pancreas” as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Society for Primary Care Gastroenterology, European Society of Pathology, European Society of Gastrointestinal Endoscopy, European Society of Gastrointestinal and Abdominal Radiology, European Association for the Study of the Liver, European Pancreatic Club