Endoscopic treatment by placement of a vacuum sponge drainage system is a new option in the management of leakages in the digestive tract. We now distinguish between two treatment variants: the intracavitary and intraluminal techniques. A drainage system comprising an appropriately trimmed polyurethane foam sponge and a gastric-type tube is either placed through the esophageal defect into an extraluminal wound cavity (intracavitary method), or directly onto the defect with the sponge remaining within the esophageal lumen (intraluminal method). Continuous negative pressure of 125 mmHg is then applied, resulting in stabilizing of the sponge and continuous drainage and sealing of the defect. We report a case series of 14 patients, presenting the full range of possible esophageal defects that were successfully treated with either intracavitary or intraluminal vacuum therapy. Complete healing of the esophageal defect was achieved in 13 patients; one patient died due to fulminant pseudomembranous colitis while the esophageal defect was nearly healed.

Endoscopic vacuum therapy is applicable for a wide range of esophageal defects. In the authors' experience, it has seemed to be the best choice for iatrogenic perforations and has been a potent supplement in the management of anastomotic leakages.

Background and study aims  Endoscopic negative pressure therapy (ENPT) has been developed to treat gastrointestinal leakages. Up to now, ENPT has usually been performed with open-pore polyurethane foam drains (OPD). A big disadvantage of the OPDs is their large diameter. We have developed a new, small-bore open-pore film drainage (OFD). Herein we report our first experience in a case series of 16 patients. Patients and methods  OFD is constructed with a drainage tube and a very thin double-layered open-pore drainage film (Suprasorb CNP, Drainage Film, Lohmann & Rauscher International, Germany). The distal end of the tube is wrapped with only one layer of film. OFD is placed into the gastrointestinal leakage site with common endoscopic techniques. The tube is connected to an electronic vacuum device and continuous negative pressure of –125 mmHg applied. Results  From 2013 to 2016, 16 patients were treated with the new OFD device. In 10 patients, transmural intestinal defects (4 esophageal, 4 rectum/colon, 1 duodenal, 1 pancreatic cyst) were closed with ENPT in median time of 12 days (range 3 – 34 days). Five of the 10 patients were treated solely with OFD devices. In five patients ENPT started with ODP and changed to OFD when the cavity was shrunken to a channel with a small opening. In four patients postoperative gastric reflux was eliminated for 5 to 16 days. Conclusions  Small-bore OFD opens up promising new treatment options within ENPT. OFD can be used in endoscopic closure management of intestinal leakages in the upper and lower gastrointestinal tract. Gastric reflux can be eliminated in an active manner. OFD can be inserted nasally. OFD may be an adequate substitute for OPD, especially when placement of the larger OPD is difficult.

Esophageal anastomotic insufficiency and esophageal wall defects of other causes can be treated successfully with endoscopic vacuum sponge therapy.

The results of this retrospective study emphasize the increasing importance of endoscopic vacuum therapy in the current literature as an endoscopic treatment method in the management of esophageal perforation and anastomotic leakage.