Esophageal stenting and endoscopic vacuum therapy for esophageal defects: a systematic review and meta-analysis of observational studies.

BACKGROUND

Spontaneous esophageal perforation, especially Boerhaave syndrome, carries high morbidity and mortality. Minimally invasive treatments like esophageal stenting and endoscopic vacuum therapy (EVT) are increasingly used, but optimal management remains unclear.

OBJECTIVE

This systematic review and meta-analysis evaluates the efficacy and safety of esophageal stenting and EVT in managing esophageal defects by assessing sealing rates, failure rates, and mortality.

METHODS

A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library through 24 March 2025. Only observational studies and case series were included. Primary outcomes were the pooled sealing rate, failure rate, and mortality for stenting, and the closure rate for EVT. Data were analyzed using a random-effects model, with heterogeneity assessed by the statistic.

RESULTS

Twenty stenting studies (245 patients) showed a pooled sealing rate of 86.1% (95% CI: 80.2-92.0%) and a failure rate of 14.9% (95% CI: 8.5-21.3%). Stent-related mortality was 7.4% (95% CI: 3.5-11.4%). Thirteen EVT studies (424 patients) demonstrated a pooled sealing rate of 54.1% (95% CI: 34.8-73.4%) with high heterogeneity (  = 98.24%). After sensitivity analysis, the EVT sealing rate rose to 89.6% (95% CI: 83.9-95.3%).

CONCLUSION

Both esophageal stenting (86.1% success) and EVT (54.1% overall; 89.6% post-sensitivity) effectively close esophageal defects. However, EVT's heterogeneity and the observational design of studies limit definitive conclusions. These findings affirm stenting's role and suggest EVT's promise, yet emphasize the urgent need for randomized controlled trials to establish evidence-based guidelines.