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.
