Gastrointestinal transmural defects refer to a spectrum of conditions characterized by full-thickness rupture of the gastrointestinal wall. These defects are associated with high morbidity and mortality rates and often require prolonged hospital stays. Endoscopic vacuum therapy (EVT) has played an increasingly important role in managing these defects. The VacStent GI (MicroTech) is a novel device that synergistically combines the advantages of fully covered self-expanding metal stents (fcSEMS) with the principles of EVT.

We prospectively analysed patients who underwent treatment for transmural oesophageal defects using VacStent between October 2023 and November 2025 at two tertiary referral centers in the United Kingdom. The primary outcome was clinical success, defined as the endoscopic and radiological evidence of defect closure. Secondary outcomes included the number of VacStent exchanges, technical success, serious adverse device effects (SADE), and time to defect closure.

Of the 22 patients treated (median age 66 years, IQR 58-73.5; 73% male), 12 (55%) had anastomotic leakage after oesophageal resection, 6 (27%) had iatrogenic defects post gastroscopy, and 4 (14%) had Boerhaave's syndrome. The median defect size was 9 mm (IQR 6-13.5). Clinical success was achieved in 73% of cases, with a technical success rate of 100%. The median time to defect closure was 11 days (IQR 5-14), requiring a median of 1 VacStent exchange (IQR 0-2). Of the 6 patients in which VacStent failed, 3 had defects within the surgical conduit, 2 had large associated cavities, and 1 was clinically unstable; thus, stent exchange was abandoned.

Our multi-centre data demonstrates that VacStent therapy for transmural GI defects in the oesophagus is both safe and effective, with a clinical success rate of 73%. A standardised pathway and protocol are needed to optimise management and improve outcomes for this challenging patient population. Higher quality data is needed as most of the literature consist of case series.