Endoluminal vacuum-assisted closure for pediatric esophageal leaks: Outcomes and factors associated with clinical success.

PURPOSE: Esophageal leaks in children are associated with significant morbidity. While they are traditionally managed with prolonged fasting and drains, endoluminal vacuum-assisted closure (EVAC) is a minimally invasive alternative. We evaluated outcomes and factors associated with EVAC success.

METHODS

Retrospective single-center review of pediatric patients treated with EVAC for esophageal leaks (2019-2025). Leak episodes were analyzed independently. Data included leak characteristics, timing of EVAC initiation, procedural details, and outcomes. The primary outcome was leak resolution without surgery.

RESULTS

Thirty-eight children with 40 leak events were included. Median age was 1.5 years (IQR 0.6-2.5). Etiologies included postsurgical (53%), endoscopic (45%), and perforation due to foreign body ingestion (2.5%); 78% were contained leaks. EVAC achieved leak resolution without surgery in 83% of cases (94% endoscopic vs 71% surgical). Median time to closure was 11 days (IQR 6-16). Median number of EVAC exchanges was 2 (IQR 1-3). During EVAC therapy, most patients maintained enteral post-pyloric feeding (65%), and drains were only required in 26%. No EVAC-related adverse events occurred. Strictures requiring surgery developed in 31%.

CONCLUSION

EVAC is an effective treatment strategy for pediatric esophageal leaks, with high rates of leak resolution without surgery. Many patients were managed without pleural drainage while maintaining enteral nutrition, supporting EVAC as an active treatment option for selected pediatric esophageal leaks.