Endoscopic vacuum therapy (EVT) has emerged as an effective, minimally invasive treatment for gastrointestinal (GI) leaks, perforations, and fistulas. However, clinical outcomes across various GI locations remain underreported in Asian populations. This study aimed to evaluate the therapeutic efficacy and safety of EVT for upper and lower GI defects in a single tertiary center.

Patients who underwent EVT for GI leakage, perforation, or fistula at Pusan National University Hospital between February 2020 and October 2025 were retrospectively analyzed. Thirty-three patients (36 procedures) were included; one patient had two defects, and another had three. Treatment success was defined as complete closure without endoscopic or surgical re-intervention.

Among 36 procedures, 30 (83.3%) were leaks, 3 (8.3%) perforations, and 3 (8.3%) fistulas. The upper GI tract accounted for 88.9% of cases. EVT was primarily applied as first-line therapy in 97.2%. The median interval from diagnosis to EVT initiation was 2 days (range, 0–9,163). Treatment success was achieved in 25 cases (69.4%), with a mean of 4.94 sessions per lesion. Of these, 22 (61.1%) were treated with the intraluminal approach and 14 (38.9%) with the intracavity approach. Complications occurred in three patients (9.1%), including two cases of GI bleeding and one of stricture. 

EVT demonstrated favorable outcomes and acceptable safety for managing GI leaks, perforations, and fistulas across both upper and lower GI tracts. These findings support EVT as an effective minimally invasive treatment in selected patients, potentially reducing the need for surgical intervention.