Endoscopic vacuum therapy has been used in treating leakages and perforations in gastrointestinal tract. For patients having a larger leakage cavity, the standard-sized sponge for upper gastrointestinal leakages can be too small, being only 5cm long. Even though it is possible to place two sponges, it would also mean two nasal tubes resulting in increased discomfort for the patient and may challenge the swallowing process. Taking this into consideration, novel techniques to cover larger cavities is needed.

A tailored-made sponge solution was created for larger cavities. A second sponge was fastened above the original sponge with non-absorbable sutures. The original nasal tube was pierced to allow the air to flow into the vacuum system.  The original overtube was cut to accommodate the new length of the combined sponge enabling a feasible the placement of the lengthened sponge. The innovation was tested with a patient having a complex, large fistula cavity at the resection line of the stomach which did not respond to standard therapeutic options.

The sponge was prepared for the patient before the visit at the outpatient clinic.

Insertation of the combined sponge solution was feasible when the overtube was cut accordingly. 

During the therapy, the vacuum-sponge was changed once a week. The double sponge needed was tightly attached to the cavity walls showing good contact. During the changes a longer moisturizing time was used to safely remove or change the system.

Minimal bowel content was detected in the cavity during the sponge changes demonstrating a  sufficient occlusion of the mouth of the fistula.  

The sutures and sponges stayed intact during the therapy and the vacuum through the sponge shrank the cavity. 

The developed sponge solution was found to offer an alternative techinique for vacuum therapy of complex cavities.