This case report describes the successful use of a VacStent, a hybrid device that combines a fully covered self-expanding metal stent (SEMS) with an external polyurethane sponge cylinder connected to continuous negative-pressure therapy, in the management of an esophageal fistula that developed after surgical resection of an adenocarcinoma located in the distal esophagus and cardia. The aim is also to highlight the essential role of the endoscopy nurse in ensuring safe and effective treatment.

Following surgery, the patient developed post-procedural complication, a stapler-related anastomotic esophageal stenosis, with a residual lumen of 2 mm. Subsequently, endoscopic dilatation was performed to sufficiently widen the esophageal lumen, allowing safe placement of the VacStent.The stent was placed endoscopically in the endoscopy room, under X-ray fluoroscopy. The stent was withdrawn 9 days later, following the same endoscopic protocol.The endoscopy nurse prepared all endoscopic acccesories – including the VacStent delivery system, suction catheter, and vacuum pump – ensured proper setup, and verified negative-pressure function before the procedure. During placement, the nurse assisted by handling the endoscopic accessories, adjusting suction in real time, and coordinating with the endoscopist to achieve precise positioning of the device. After deployment, the nurse continuously monitored the vacuum system, checked for signs of discomfort or complications, and collaborated with the multidisciplinary team to optimize timing based on healing progress.

Literature supports the VacStent’s safety and efficacy: in a prospective multicenter study, 41 implants in 15 patients achieved a healing rate of 80% with no severe device-related adverse events.(1)A systematic review of 65 patients showed 100% technical success and 77% clinical success.Moreover, in a pilot study, preemptive application of the VacStent after esophagectomy demonstrated feasibility and no major complications.

This report highlights the therapeutic potential of the VacStent in managing postoperative esophageal fistulas and underscores the indispensable role of the endoscopy nurse in ensuring safe, efficient, and patient-centered care in the endoscopy suite.