{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:14:34Z","timestamp":1775042074312,"version":"3.50.1"},"reference-count":51,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,7]],"date-time":"2024-07-07T00:00:00Z","timestamp":1720310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Anastomotic insufficiencies (AI) and perforations of the upper gastrointestinal tract (uGIT) result in high morbidity and mortality. Endoscopic stent placement and endoluminal vacuum therapy (EVT) have been established as surgical revision treatment options. The Eso-Sponge\u00ae is the only licensed EVT system with limitations in treating small defects (&lt;10 mm). Therefore, a fistula sponge (FS) was developed for the treatment of such defects as a new therapeutic approach. The aim of this study was to evaluate both EVT options\u2019 indications, success rates, and complications in a retrospective, comparative approach. Materials and Methods: Between 01\/2018 and 01\/2021, the clinical data of patients undergoing FS-EVT or conventional EVT (cEVT; Eso-Sponge\u00ae, Braun Melsungen, Melsungen, Germany) due to AI\/perforation of the uGIT were recorded. Indication, diameter of leakage, therapeutic success, and complications during the procedure were assessed. FSs were prepared using a nasogastric tube and a porous drainage film (Suprasorb\u00ae CNP, Lohmann &amp; Rauscher, Rengsdorf, Germany) sutured to the distal tip. Results: A total of 72 patients were included (20 FS-EVT; 52 cEVT). FS-EVT was performed in 60% suffering from AI (cEVT = 68%) and 40% from perforation (cEVT = 32%; p &gt; 0.05). FS-EVT\u2019s duration was significantly shorter than cEVT (7.6 \u00b1 12.0 d vs. 15.1 \u00b1 14.3 d; p = 0.014). The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT (p &lt; 0.001). Therapeutic success was achieved in 90% (FS-EVT) and 91% (cEVT; p &gt; 0.05). Conclusions: EVT comprises an efficient treatment option for transmural defects of the uGIT. In daily clinical practice, fistulas &lt; 10 mm with large abscess formations poses a special challenge since intraluminal cEVT usually is ineffective. In these cases, the concept of extraluminal FS placement is safe and effective.<\/jats:p>","DOI":"10.3390\/medicina60071105","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T04:52:49Z","timestamp":1720414369000},"page":"1105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endoluminal Vacuum Therapy Using a New \u201cFistula Sponge\u201d in Treating Defects of the Upper Gastrointestinal Tract\u2014A Comparative, Retrospective Cohort Study"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6190-9259","authenticated-orcid":false,"given":"Florian","family":"Richter","sequence":"first","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Conrad","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Reichert","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Witigo","family":"von Schoenfels","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens","family":"Schafmayer","sequence":"additional","affiliation":[{"name":"Department of General Surgery, University Hospital Rostock, 18057 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Hendrik","family":"Egberts","sequence":"additional","affiliation":[{"name":"Department of Surgery, Israelitisches Krankenhaus, 22297 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Ellrichmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.surg.2009.06.058","article-title":"Contemporaneous management of esophageal perforation","volume":"146","author":"Abbas","year":"2009","journal-title":"Surgery"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.athoracsur.2003.08.037","article-title":"Evolving options in the management of esophageal perforation","volume":"77","author":"Brinster","year":"2004","journal-title":"Ann. 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