Endoscopic vacuum-assisted therapy of infected pancreatic pseudocyst using a coated sponge
06 March 2012 (online)
Endoscopic vacuum-assisted therapy (EVAT) is a reliable treatment for endoscopically accessible abscesses and was recently described in the management of infected pancreatic pseudocyst (IPC)    .
EVAT when performed in the region of the celiac trunk und portal venous system has, in theory, a higher risk of bleeding than when performed in other regions of the body. We treated a woman who had sepsis due to an IPC, chronic pancreatitis, and pronounced gastric varices by EVAT, but with a coated sponge.
The treatment was generally performed as previously described . After 1 week of endoscopic therapy the cyst was free of necrosis and we started EVAT. We adjusted the size of the sponge according to the local topography and wrapped the Endo-SPONGE (B. Braun, Melsungen, Germany) in one layer of Suprasorb CNP Drainage Film (Lohmann & Rauscher, Vienna, Austria), a double-layered film for vacuum therapy of wounds ([Fig. 1] and [Fig. 2]) . This set is not commercially available. Secretions were continuously evacuated with a suction of 120 mm Hg (16 kPa). We replaced the coated Endo-SPONGE system on the third day and finished EVAT on the seventh day.
The extraction of the wrapped Endo-SPONGE-system was, compared with the extraction of a pure sponge, easier, with less pulling force ([Fig. 3]). The transgastric access into the cyst was also smoother and less bloody ([Fig. 4]). On the seventh day of EVAT the pseudocyst was resolved. Finally we closed the gastrocystic fistula with metallic clips and one Endoloop (Olympus, Tokyo, Japan) ([Fig. 5]).
No complications occurred during therapy and within 6 months after therapy. The treatment of IPC was completed during a single hospital stay.
In our opinion the coated sponge is an improvement in EVAT of infected pancreatic pseudocyst, because it simplifies the extraction of the Endo-SPONGE system and reduces the bleeding risk.
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