Negative Pressure - Positive Outcome: Endoscopic Vacuum Therapy in Failed Primary Surgical Repair of Boerhaave Syndrome

Esophageal perforations remain a challenge for treating gastroenterologists, mostly managed through primary surgical intervention. However, the recent advances in minimally invasive nonsurgical endoscopic techniques have complemented a positive outcome as primary treatment. Endoscopic approaches such as full-thickness clipping, covered stent placement, endoscopic suturing, and novel endoscopic vacuum therapy (EVT) have been shown success in complete healing in appropriate clinical situations. The utility of these techniques is constrained by patient clinical condition, size, location, and available expertise. Larger or irregular defects, postoperative failed closures are not suitable for clipping and stent placement, as a complete seal may not be achieved. Consequently, EVT is emerging as a valuable addition in the therapeutic armamentarium, offering an effective, relatively cheap, and less invasive alternative for selected patients with complicated esophageal perforations. Here, we share our experience of managing a 58-year-old obese female with spontaneous esophageal perforation who underwent surgical closure as primary treatment, but persisted to have a mediastinal leak in the postoperative period. EVT bailed her from the morbid condition and provided complete closure of the defect. Uniqueness here is that we used an antimicrobial drape instead of a sponge, which made easier insertion of the tube endoscopically with a good clinical outcome.