Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?

Purpose of review This article provides a comprehensive review of the endoscopic treatment of non-malignant esophageal perforation (NMEP), highlighting endoscopic vacuum therapy (EVT) and its benefits compared to other therapies based on the available data and in our experience in the management of this condition. Recent findings The treatment of NMEP is challenging, often being a life-threatening situation. Historically, the management was always performed surgically, although associated with significant morbidity and mortality. Less invasive approaches such as endoscopic therapies are now preferred for clinically stable patients. There is no data to state a gold standard approach; thus, treatment needs to be individualized. EVT use is increasing worldwide due to its unique mechanism of action and satisfactory outcomes. Summary EVT should be considered the best approach for NMEP, except for clinically unstable patients with uncontained collection. EVT has an adequate safety profile and presents a higher clinical success rate than any other endoscopic therapies for NMEP as a primary or rescue therapy, as an individual or adjunctive therapy, in defect with or without associated collection, regardless of defect location or duration. Thus, we are positive that it is time to go vacuum for NMEP!