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Endoscopy 2018; 50(02): 148-153
DOI: 10.1055/s-0043-120442
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Stent-over-sponge (SOS): a novel technique complementing endosponge therapy for foregut leaks and perforations

Piero V. Valli   *
1   Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
,
Joachim C. Mertens   *
1   Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
,
Arne Kröger
1   Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
,
Christoph Gubler
1   Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
,
Christian Gutschow
2   Department of Visceral and Transplant Surgery, University Hospital Zürich, Zürich, Switzerland
,
Paul M. Schneider
2   Department of Visceral and Transplant Surgery, University Hospital Zürich, Zürich, Switzerland
3   Center for Visceral-, Thoracic and specialized Tumor Surgery, Hirslanden Medical Center, Switzerland
,
Peter Bauerfeind
1   Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

submitted 16 May 2017

accepted after revision 21 August 2017

Publication Date:
27 October 2017 (online)

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Abstract

Background and study aims Endoluminal vacuum therapy (EVT) has evolved as a promising option for endoscopic treatment of foregut wall injuries in addition to the classic closure techniques using clips or stents. To improve vacuum force and maintain esophageal passage, we combined endosponge treatment with a partially covered self-expandable metal stent (stent-over-sponge; SOS).

Patients and methods Twelve patients with infected upper gastrointestinal wall defects were treated with the SOS technique.

Results Indications for SOS were anastomotic leakage after surgery (n = 11) and chronic foregut fistula (n = 1). SOS treatment was used as a first-line treatment in seven patients with a success rate of 71.4 % (5/7) and as a second-line treatment after failed previous EVT treatment in five patients (success rate 80 %; 4/5). Overall, SOS treatment was successful in 75 % of patients (9/12). No severe adverse events occurred.

Conclusion SOS is an effective method to treat severely infected foregut wall defects in patients where EVT has failed, and also as a first-line treatment. Comparative prospective studies are needed to confirm our preliminary results.

* Contributed equally to this work.


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  • References

  • 1 Gubler C, Bauerfeind P. Self-expandable stents for benign esophageal leakages and perforations: long-term single-center experience. Scand J Gastroenterol 2014; 49: 23-29
    PubMedGoogle Scholar
  • 2 Thompson JT, Marks MW. Negative pressure wound therapy. Clin Plast Surg 2007; 34: 673-684
    CrossrefPubMedGoogle Scholar
  • 3 Mees ST, Palmes D, Mennigen R. et al. Endo-vacuum assisted closure treatment for rectal anastomotic insufficiency. Dis Colon Rectum 2008; 51: 404-410
    CrossrefPubMedGoogle Scholar
  • 4 Wedemeyer J, Schneider A, Manns MP. et al. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 2008; 67: 708-711
    CrossrefPubMedGoogle Scholar
  • 5 Kuehn F, Loske G, Schiffmann L. et al. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc DOI: 10.1007/s00464-016-5404-x.
    PubMedGoogle Scholar
  • 6 Gubler C, Schneider PM, Bauerfeind P. Complex anastomotic leaks following esophageal resections: the new stent over sponge (SOS) approach. Dis Esophagus 2013; 26: 598-602
    CrossrefPubMedGoogle Scholar
  • 7 Schneider PM, Georg L, Bauerfeind P, Schiesser M. Esophageal and gastric injuries. In: Ostern H-J, Trentz O, Uraneus S. , eds. European Manual of Medicine series: Head, Thoracic, Abdominal, and Vascular Injuries. Heidelberg, Dordrecht, London, New York: Springer Verlag; 201 263-274
    CrossrefGoogle Scholar
  • 8 Dumonceau JM, Riphaus A, Schreiber F. et al. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline--Updated June 2015. Endoscopy 2015; 47: 1175-1189
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Patrick PG, Marulendra S, Kirby DF. et al. Endoscopic nasogastric-jejunal feeding tube placement in critically ill patients. Gastrointest Endosc 1997; 45: 72-76
    CrossrefPubMedGoogle Scholar