Stent-over-sponge (SOS): a novel technique complementing endosponge therapy for foregut leaks and perforations
submitted 16 May 2017
accepted after revision 21 August 2017
27 October 2017 (eFirst)
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.
- 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
- 2 Thompson JT, Marks MW. Negative pressure wound therapy. Clin Plast Surg 2007; 34: 673-684
- 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
- 4 Wedemeyer J, Schneider A, Manns MP. et al. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 2008; 67: 708-711
- 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.
- 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
- 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
- 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
- 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