Endoscopic endoluminal therapy with the Eso-SPONGE® system as a treatment of spontaneous esophageal perforation with associated paraesophagal collection.

We present the case of a 92-year-old woman with no relevant history, who consulted for sore throat, progressive dysphagia to solids and fever. A cervical-thoraco-abdominal CT was performed with the finding of a paraesophageal collection at the level of C3-T1 without a clear solution of continuity, although with passage of oral contrast to the collection, exerting a mass effect on the esophageal lumen, suggestive of contained esophageal perforation, of cause not clarified. A gastroscopy was performed, in which three esophageal fistulous orifices were observed, two 4-5 mm, and a third 10 mm deeper, located 22cm from the dental arch, septate, with perilesional purulent material and bubbling. Esophageal endoluminal vacuum therapy with the Eso-SPONGE® system is an innovative, minimally invasive, effective and safe therapy, usually well tolerated, for the treatment of anastomotic leaks after spontaneous or iatrogenic esophageal resection or esophageal perforation. It is therefore an alternative technique to the use of other therapeutic endoscopic procedures in esophageal fistulas, such as the use of Over-the-scope (OTSC®), covered esophageal metal stents, with a high therapeutic success rate (80-100%). and a low rate of complications, which translates into a reduction in morbidity and mortality in this type of patient.