The aim of this study is to describe the clinical, laboratory and endoscopic characteristics of patients submitted to endoscopic vacuum therapy (EVT) for treatment of fistulas and perforations in the gastrointestinal (GI) tract at a Brazilian tertiary care center, as well as indications, success rate and treatment-related complications. 

This retrospective study included patients referred between November 2019 and April 2025 to the State University of Campinas, Brazil, with perforation or fistula in the GI tract. All patients were admitted and treated with EVT using a low-cost customized nasogastric tube (16 Fr) coated with fenestrated film. This system was connected to the wall suction system and a 20F intravenous catheter was connected to the tube to maintain a negative pressure between -75 and -150 mmHg.  Endoscopic control examinations after the end of treatment were performed on outpatient basis. Demographic, diagnosis-related and treatment data were obtained during the follow-up of the patients.

Forty-two patients were submitted to EVT during the study period. One patient was submitted to two EVT at the same time resulting in 43 fistulas treated. Twenty-nine (59.5%) patients were men. The mean age was 58 years (18-86 years). The indication for EVT was divided into three groups: postoperative, spontaneous and iatrogenic, which corresponded to 87%, 9% and 4%, respectively. Regarding the site, most defects occurred in the cervical and distal esophagus (both 37.2%). EVT was the primary therapy in 71.4%. The remaining fistulas had undergone surgical treatment (19%) or placement of a stent (9.52%) previously.  In the postoperative cases, fistula was diagnosed within an average of 17.8 days (1-90 days) after surgery. On endoscopic assessment, the diameter of the orifice ranged from 0.5 to 7 cm (mean 1.8 cm) and the cavity extension ranged from 0 (without cavity) to 18 cm (mean 5.9 cm). The tube was changed once a week, with a mean of 3.1 changes (0-16 changes). The mean duration of treatment was 24.8 days (5-184 days) and the total length of hospital stay ranged from 5 to 212 days. During EVT, the patients were evaluated clinically and by laboratory tests. Pre- and post-treatment laboratory analysis revealed a significant decrease in white blood cell counts (WBC) (7,305 vs 13,380/mm³, p<0.001) and C-reactive protein (CRP) levels (126 vs 40 mg/L, p<0.001). The success rate of treatment was 81.8%, 9.1% failed and 9.1% discontinued treatment. There were no complications or deaths related to the treatment. The mean follow-up time was 9.1 months. 

Despite the limited number of patients, modified EVT was found to be a safe, low-cost and effective method for the treatment of defects in the GI tract, especially postoperative fistulas. WBC and CRP can be used as parameters indicating improvement during the treatment of these patients.