Purpose of Study A leak following elective oesophago-gastric surgery is a serious event, causing significant short and long-term complications. One major post-operative complication is uncontrolled sepsis which is associated with increased morbidity, mortality, length of hospitalisation, and stay in intensive care. The purpose of this study was to investigate whether endoluminal vacuum therapy (EVT) could be used in the prophylactic setting as a preventive strategy to minimise secondary sepsis related sequelae and morbidity from an oesaphago-gastric leak. Methods We prospectively identified high risk patients undergoing oesophago-resection between March 2021 and June 2023. The selection was based on patient, technical, and intra-operative factors. The primary outcome measure was post-operative anastomotic leak rate; the secondary outcome measure was length of hospital stay. Results
 A total of 24 patients met the eligibility criteria. The median duration of treatment in our study cohort was 7 days (range = 5-14 days). One patient (4.17% of the total cohort) developed a full thickness microleak at endoscopic evaluation. The median length of hospital stay was 15 days (range = 6-67 days). The two longest stays were secondary to complications unrelated to the anastomosis. Conclusions This is the largest prospective study to date investigating the effects of prophylactic EVT as an adjunct for surgical management of patients who are identified at high risk for leak. Only one patient developed a leak with prophylactic EVT in our study, yet remained clinically well with ward based care. There were no adverse events in any patients.