Endoscopic vacuum therapy for a refractory sigmoid fistula.

BACKGROUND AND AIMS: Sigmoid fistulas pose significant management challenges, often requiring prolonged antibiotics, percutaneous drainage, and surgical intervention. Endoscopic vacuum therapy (EVT), used for gastrointestinal tract leaks and fistulas, promotes granulation and controlled closure using continuous negative pressure. Its application in sigmoid fistulas is less commonly reported. Thus, we present a case demonstrating successful EVT for a persistent sigmoid fistula, highlighting technical considerations and treatment course. The aims of this article are to share clinical rationale, illustrate procedural steps, and summarize EVT applications and benefits to describe EVT as a potential option for managing complex gastrointestinal tract defects. METHODS: An initial closure attempt using a helical tack-based suturing system (Boston Scientific, Marlborough, Mass, USA) was unsuccessful. A later attempt using a full-thickness endoscopic suturing system also failed. Granulation and defect closure were subsequently achieved using EVT via intracavitary sponge placement and serial exchanges. Imaging and endoscopic findings were documented to illustrate technique, healing progression, and treatment outcomes. RESULTS: The patient's sigmoid fistula was successfully closed using EVT over the course of approximately 2 months. CONCLUSIONS: EVT is an effective minimally invasive closure technique in the management of sigmoid fistulas. This case highlights EVT as a valuable therapeutic option for lower gastrointestinal fistulas, offering safe, reproducible, and organ-preserving management.