BSG Clinical Services Excellence Award 2026 highly commended submission by Dr Nasar Aslam, Consultant Gastroenterologist.

Applicants: Dr Nasar Aslam, Consultant Gastroenterologist, Dr Vinay Sehgal, Consultant Gastroenterologist, Dr Yassar Qureshi, Consultant Upper GI surgeon, Dr David Leonard, Endoscopy Fellow.

Institution: University College London Hospitals NHS Foundation Trust, University Hospitals of Derby & Burton NHS Foundation Trust.

What were the challenges and why did the service need to change?

Oesophageal transmural defects represent a challenging complication following upper gastrointestinal surgery and endoscopy. They are associated with significant morbidity and mortality alongside prolonged hospital admissions. Traditional management strategies included surgical revision and endoscopic management, but these have historically yielded suboptimal outcomes.

Endoscopic vacuum therapy (EVT) using sponge-based systems has emerged as an effective treatment option for these defects. Unfortunately, traditional sponge based EVT presents limitations that impact both patient experience and clinical outcomes. The sponge completely occludes the oesophageal lumen, preventing oral intake and necessitating either total parenteral nutrition (TPN) or distal enteral feeding. Furthermore, they require frequent exchanges every 3-5 days under general anaesthesia, increasing the associated procedural risks and healthcare costs.   

The VacStent GI device combines the principles of fully covered self-expanding metal stents with vacuum therapy. The concept of stent based EVT was introduced to Dr Sehgal at a European endoscopy meeting. Unlike traditional sponges, the VacStent features a patent central lumen that allows liquid oral nutrition whilst maintaining vacuum drainage of the defect. Furthermore, it only requires exchange every 7 days.   

However, the device was novel and unfamiliar requiring specialised expertise in both advanced endoscopy and vacuum therapy. Without clinical experience, outcome data, or established protocols, there was limited options for patients to access this treatment. Furthermore, introducing a VacStent service presented several challenges. Patients are often multi-morbid requiring prolonged periods of high-level care. There are also difficulties with accessing general anaesthesia lists and managing the accessory vacuum pump on the wards.

Given the potential of VacStent to transform patient care we took on the challenge to establish a VacStent service that could improve outcomes for patients whilst maintaining safety and being reproducible across other centres. 

How did you overcome the challenges?

Establishing a VacStent service required a systematic approach and crucially collaboration between medical and surgical specialities.

Phase 1: Service Introduction at UCLH (2023-2024) 

As Dr Vinay Sehgal's Endoscopy fellow and under his guidance I helped introduce the VacStent device at UCLH. We designed a comprehensive patient pathway involving an MDT based approach. Crucially, we instituted data collection from the outset to build an evidence base for VacStent.

Phase 2: Evidence Generation and Dissemination (2023-2025)

Following the successful implementation of the VacStent service we then presented our experience through multiple channels. I delivered presentations at major national and international conferences including DDW, ESGE and the BSG annual meeting. I have also presented outcome data at regional meetings in the UK. To address the educational gap in EVT more broadly, I authored with Dr Vinay Sehgal and Mr Yasser Qureshi a comprehensive article on EVT for the BSG web education platform.

Phase 3: National Educational Initiative (2025)

A barrier to wider adoption was the lack of hands-on training opportunities in EVT. To address this, we organised the first UK EVT Masterclass at UCLH in October 2025, bringing together expert faculty to deliver theoretical teaching and practical hands-on sessions with both VacStent and traditional Eso-SPONGE systems.

Phase 4: Service Replication at Royal Derby Hospital (2024-2025)

To demonstrate reproducibility and scalability, I helped introduce VacStent therapy to University Hospitals of Derby and Burton NHS Foundation Trust. This involved introducing the concept to the upper GI MDT and writing the business case for device procurement, arranging training for the nursing team and personally supporting cases. The successful establishment of this second centre demonstrated that the VacStent service model could be replicated beyond London, making it accessible to a broader patient population.

Phase 5: Multi-centre Collaboration and Future Development (2025-2026) 

The collaboration between UCLH and Derby has created the world's largest cohort of VacStent treated patients. We are now building on this work through two initiatives: a consensus exercise using Delphi methodology to establish best-practice guidance, and the development of a national registry to prospectively capture outcomes across UK centres adopting this technology.

What were the outcomes?

Clinical Outcomes

Our multi-centre case series consists of 24 patients treated with 47 VacStent devices between October 2023 and December 2025. The cohort included anastomotic leaks post Oesophagectomy (54.2%), iatrogenic defects (29.1%), and spontaneous perforations (16.7%). Clinical success, defined as complete defect closure on both endoscopic and radiological assessment, was achieved in 75% of patients (18/24). Technical success was 100%. The median time to defect closure was 11 days (IQR 7.25-14 days). The status quo for this patient cohort being 8-12 weeks with conventional management strategies. Patients required a median of one stent exchange (IQR 0-2), fewer than the 6-8 procedures typically needed with traditional sponge EVT. 

What were the learning points and how can this influence other teams?

Key Learning Points

• Multi-centre collaboration accelerates innovation: The partnership between UCLH and Derby demonstrated that combining expertise and patient volumes creates evidence more rapidly than single-centre work. Other teams should consider early collaboration when introducing novel technologies.
• Prospective data collection: By capturing outcomes systematically from the first case, we built an evidence base that supported service expansion. Teams introducing new interventions should institute data collection protocols from the outset.
• Education must precede widespread adoption: The EVT Masterclass model demonstrated that hands-on training with expert mentorship effectively transfers complex skills. Innovative services should incorporate structured educational components to facilitate safe replication.
• Standardisation improves quality: The heterogeneity in our patient outcomes highlighted the need for consensus-based protocols. The Delphi exercise and national registry will address this, providing a framework other teams can adopt.
• Patient-centred outcomes matter: The ability to eat and drink during treatment, though not a traditional clinical endpoint, profoundly affected patient experience. Service innovations should explicitly consider quality-of-life outcomes.
• Replicability requires system-level thinking: Successfully establishing the Derby service required business case development, SOP formation, and multidisciplinary training, this was more important than the technical skills involved. Teams should plan for these organisational elements when adopting innovations.
• Influence on Other Teams: This work provides a replicable blueprint for introducing VacStent EVT services nationally. The educational resources, clinical protocols, and outcome data lower the barrier for other centres to establish similar services.