Two-sided sponge (TSS) treatment - a modified endoscopic vacuum technique for anastomotic leaks and perforations in the upper gastrointestinal tract and small bowel

Introduction Endoscopic vacuum therapy (EVT) is a highly effective treatment of anastomotic leaks and perforations in the gastrointestinal tract. However, due to its size and elasticity, reaching and precise application of the sponge into lesions distal the esophagus or above the rectum is challenging. In 2014, a modified technique for EVT has been proposed. For „two-sided sponge“(TSS) treatment, the sponge system is connected to a percutaneous abdominal drain [1]. Subsequently, the sponge can be moved independently of the endoscope by pulling either the abdominal drain or the oral drain.

Aims and methods In this retrospective study, we report on 30 consecutive cases treated with TSS due to leaks and perforations in the upper GI tract and small bowel at our institution between 2012 and 2020. Primary endpoints were healing of the lesion and avoidance of revisional surgery, secondary endpoints were procedure-related complications, technical procedural data (e.g. number of sponge exchanges), length of hospital stay and in-hospital mortality.

Results Mean age was 57 (±15) years. Indication for TSS was anastomotic leakage in 63% of cases (19/30), and acute perforation in 37% of cases (11/30). The lesions were located in the esophagus in 20% (6/30), stomach in 43% (13/30), duodenum in 20% (6/30) and jejunum in 17% (5/30) of cases. Placement of TSS was successful in all cases. Sponges were exchanged after 4-5 days, a median of 4 sessions were necessary (range 2-20). Median length of stay was 70 days (range 34-136). Successful healing of the lesion with TSS alone was achieved in 70% of cases (21/30). In 3 cases a residual leak after TSS was successfully treated by temporary stent placement. Taken together, revisional surgery could be avoided in 80% of cases. There was one minor and no major complication. In-hospital mortality was 17% with no procedure-related death. Follow-up was a median of 249 days (range 6-2634).

Conclusion Two-sided sponge therapy is a safe and effective method for treatment of leaks and perforations at difficult anatomic locations in the upper GI-tract and the small bowel. Revisional surgery can be avoided in the majority of cases.

Literatur Fischer A et al. Endoscopy. 2014;46 Suppl 1 UCTN:E218-9. doi: 10.1055/s-0034-1364951. Epub 2014 May 7.

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Artikel online veröffentlicht:
08. September 2020