Transmural gastrointestinal (GI) defects—including perforations, anastomotic leaks, and fistulae—carry significant morbidity and mortality. Salvage operations - esophagectomy, duodenal diversion, or major colorectal resection are associated with prolonged recovery and high complication rates. Modified Endoscopic vacuum therapy (mEVT) has emerged as an organ-preserving alternative that promotes granulation, drainage, and controlled defect collapse. In our centre, a modified EVT platform (mEVT) was developed to enhance adaptability, allow custom sponge/ioban configurations, and improve negative-pressure delivery in anatomically challenging locations. This study evaluates the clinical performance, safety, and organ-preserving impact of mEVT across a wide spectrum of GI defects.

A retrospective analysis of a prospectively maintained database was performed for all patients treated with mEVT. The mEVT device was assembled using a fenestrated NGT wrapped with gauze and antimicrobial incise drape or sponge, secured with three-point suturing for stability and positioning. Multiple 18G perforations enhanced uniform suction.The device was placed endoscopically and connected to continuous wall suction, with incise-drape sealing and a 20F catheter used to maintain stable negative pressure. All patients underwent EGD and contrast-enhanced CT to delineate leak size, location, associated cavities, and debris burden. Data retrieved included demographics, timing of presentation, comorbidities, etiology, leak chronicity, EVT placement technique (intraluminal, intracavitary, or combined), number of sponge exchanges, adjunctive endoscopic therapy, vacuum pressure settings, and clinical outcomes. Primary outcome was clinical success, defined as complete leak resolution. Secondary outcomes included organ preservation, requirement for rescue surgery, EVT-related complications, and adjunctive therapy utilization.

Eighteen patients underwent mEVT (mean age 54.22 ± 20.47 years; males 94.44%). Acute leaks accounted for 72.22% (13/18) and chronic defects for 27.78% (5/18). Comorbidities included DM (27.77%), HTN (27.77%), and IHD (22.22%). Prior therapy had failed in five patients. Successful closure was achieved in 10/13 (76%) acute leaks and 3/5 (60%) chronic leaks. Organ-specific healing rates were esophageal 6/8 (75%), duodenal 5/7 (71.4%), and colonic 2/3 (66.7%). Importantly, all successfully treated patients avoided major morbid surgery, preserving esophageal, duodenal, and colonic continuity. mEVT placement was intraluminal in 61.11% (11/18), intracavitary in 16.67% (3/18), and combined in 22.22% (4/18). Adjunctive endoscopic therapy included necrosectomy (2/18), endoscopic suturing (1/18), OTSC (1/18), haemoclips (5/18), specialized TTSC (1/18), and bovine pericardial patch (2/18). Only one patient required rescue surgical intervention. One patient was lost to follow-up; three deaths occurred, all unrelated to mEVT.Only 50% required sponge exchanges (mean 6.22 ± 4.99). Median hospital stay was 21.5 days. Mean vacuum pressure was 145 mmHg ± 40. No major EVT-related complications were observed.

mEVT is a safe, effective, and strongly organ-preserving treatment for GI transmural defects. In this cohort, it achieved meaningful closure rates across esophageal, duodenal, and colonic injuries while preventing major salvage surgery in nearly all responders. The modified system’s adaptability and adjunctive endoscopic options broaden its utility and justify further prospective evaluation.