Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School New Brunswick, NJ
Khyati Bidani, MD1, Vishali Moond, MD2, Vikash Kumar, MD3, Louisa Recinos-Arenas, MD1, Andrew Korman, MD1, Sugirdhana Velpari, MD1, Arkady Broder, MD, FACG1 1Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2Saint Peter's University Hospital/Robert Wood Johnson Medical School loc, New Brunswick, NJ; 3Creighton University School of Medicine, Phoenix, AZ Introduction: Gastrointestinal (GI) leaks remain a serious complication following upper GI surgery or perforation, often requiring prolonged interventions. Endoscopic vacuum therapy (EVT) has emerged as a promising modality, and the VACStent—a novel device combining a covered stent with negative pressure wound therapy—offers potential advantages by enabling simultaneous wound drainage and luminal patency. This study aims to systematically evaluate the clinical efficacy and safety of VACStent therapy in the management of GI leaks. Methods: We conducted a comprehensive literature search of PubMed, Embase, Medline, Web of Science, Cochrane Library, and relevant conference proceedings through May 2025 to identify studies reporting outcomes of VACStent therapy for upper GI leaks. Primary outcomes included technical success and clinical success. Secondary outcomes included procedure-related adverse events (AEs), bleeding, stent migration, aspiration, and other complications. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed using I² statistics. Results: Five studies were included, evaluating VACStent therapy for esophageal and upper gastrointestinal leaks. The pooled technical success rate, defined as successful device placement, was 95.5% (95% CI: 85.4%–98.7%; I² = 0%), indicating high procedural feasibility. The clinical success rate—defined as complete defect closure without surgical intervention—was 77.8% (95% CI: 67.1%–85.8%; I² = 0%), reflecting moderate overall efficacy. Adverse events were infrequent, with a pooled rate of 1.2% (0.2%–6.7%; I² = 71%), and specific complications such as bleeding (1.1%), stent migration (1.0%), aspiration (1.2%), and other minor events (1.0%) occurred at low rates. No procedure-related mortality or major complications were reported. (Table 1)
Discussion: VACStent therapy demonstrates high technical feasibility and a moderate clinical success rate in the treatment of upper GI leaks, with a favorable safety profile and low complication rates. However, the moderate success rate compared to standard EVT or stent therapy may be attributed to early device adoption, technical learning curves, and the inclusion of complex or refractory cases. Limitations of this meta-analysis include a small number of studies, limited long-term follow-up, and potential heterogeneity in outcome definitions. Further large-scale, prospective studies are needed to validate the optimal role of VACStent in clinical practice.
Figure: Table 1: Outcomes
Figure: Table 1: Outcomes
Disclosures: Khyati Bidani indicated no relevant financial relationships. Vishali Moond indicated no relevant financial relationships. Vikash Kumar indicated no relevant financial relationships. Louisa Recinos-Arenas indicated no relevant financial relationships. Andrew Korman indicated no relevant financial relationships. Sugirdhana Velpari indicated no relevant financial relationships. Arkady Broder indicated no relevant financial relationships.
Khyati Bidani, MD1, Vishali Moond, MD2, Vikash Kumar, MD3, Louisa Recinos-Arenas, MD1, Andrew Korman, MD1, Sugirdhana Velpari, MD1, Arkady Broder, MD, FACG1. P4934 - VACStent for Gastrointestinal Leaks: A Systematic Review and Meta-Analysis of Clinical Outcomes, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
