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Background and study aims Acute esophageal perforation is a potentially life-threating condition that demands a multidisciplinary approach. Based on recently published data indicating that EVT may be effective in managing esophageal perforation, we report our institution’s experience with EVT in this clinical setting. Patients and methods We retrospectively analyzed all 10 patients with acute esophageal perforation from May 2018 to January 2021, using descriptive statistics. The primary outcome was successful closure of the perforation. Secondary outcomes included the length of treatment, number of endoscopic procedures required, and complication rate. Results All patients (site of perforation: 4 upper, 2 middle, 4 lower esophagus; etiology: 8 iatrogenic, 2 foreign body ingestion) were treated with EVT successfully. In eight cases, EVT was started immediately after the perforation, in the other two cases 1 and 2 days later. The median (interquartile range) number of endoscopic procedures was 2.5 (range, 2–3) and the median duration of treatment was 7.5 days (range, 7–11.5). The sponge was placed in eight cases intraluminally, in the other two cases initially intracavitary. No complication occurred. Conclusions EVT is highly effective for managing acute esophageal perforation within 1 to 3 weeks. Immediate start of EVT to prevent abscess formation and induce defect closure is crucial.

Pemphigus vulgaris (PV) is a rare autoimmune disease affecting the skin and mucous membranes. Recent studies have shown a relatively high incidence of esophageal involvement in PV. To distinguish between the esophageal involvement of PV and other pathologies, early endoscopic evaluation is essential to obtain tissue for histological analysis. Here, we present the first case of endoluminal vacuum therapy (EVT) for a patient with esophageal involvement in PV and with associated iatrogenic perforation of the proximal esophagus. In comparison to classical treatment options for perforations of the proximal esophagus consisting of either stent insertion or surgical intervention, EVT seems to be a promising alternative with a good clinical outcome.