Endoscopy has emerged as the first-line treatment of anastomotic leaks and fistulasafter esophagogastric surgery . Endoscopic vacuum therapy (EVT) is one of the most commonly used options with clinical success above 66%. However, it is associated withhigh costs, can be technically challenging, and is associated with the need of parentalnutrition. Our center adopted a strategy using a handcrafted modified EVT (mEVT)based on a nasojejunal tube, allowing concomitant enteral nutrition. The aim of thisstudy is to evaluate the feasibility and efficacy of mEVT as single or combined therapy,in clinical practice.

We report all consecutive patients treated with mEVT in our center, between01/01/2023 and 31/10/2025 and with a 30-day follow-up period were included. All had upper gastrointestinal tract defect referred to mEVT by the multidisciplinary teamconference.

In total, 24 patients were referred to mEVT, 17 (70.8%) were male, with a median ageof 59 (IQR 54-69) years. The aetiology of the defect was predominantly postoperative(91.6%): 12 oncologic cases, 8 bariatric surgery cases (4 sleeve gastrectomies, 3bypass surgeries and 1 single anastomosis stomach–ileal bypass) and 1 iatrogenicgastric injury (intraoperative). In 17 patients (70.8%), postsurgical sepsis with organdysfunction required intensive care admission.The median defect diameter was 10.0 (IQR 5.0-25.0) mm. Diagnosis occurred, amedian of 6.0 (IQR 4-14) days after surgery and mTEV was the first-line therapeuticoption in 18 patients (75%). 12 patients (50%) had abscess cavity associated to theleak. Adjunctive endoscopic techniques were used in 15 patients (62.5%), mostlyincluding double-pigtail stents or over-the-scope clips.Clinical success was achieved in 22 patients (91.6%) after a median of 3 (IQR 2-5)sessions and the mean duration of each session was 6.03 (± 1.16) days. Fourpostoperative patients were treated without complementary percutaneous drainage.Patients required exclusive parenteral nutrition only for median of 3 days (IQR 0-7) andwere fed via enteral nutrition during a median of 14 (IQR 8-28) days, starting on theday of mEVT placement.There were no adverse events related to mEVT. Clinical failures, in 2 patients,corresponded to 2 tracheoesophageal fistulas and 1 gastrocutaneous fistula. Fourdeaths occurred: 2 due to defect-related complications and 2 due to underlyingdisease.

mEVT is an innovative and straightforward solution with a high success rate,comparable to what has been reported with conventional techniques. It stands out as alow-cost alternative, enabling optimized enteral nutrition during treatment, preventinginfection and malnutrition risk. We present iconography (endoscopic images andvideos) of the treated cases.