Fig. 3

Endoscopic view of the stomach with a post-operative pancreatogastric dehiscence (PGD). All pictures refer to the same patient (“patient no. 7”). A Large PGD orifice, approximately 15 mm in diameter, with view into the PGD-associated retrogastral wound cavity on first endoscopic encounter (day 0). The remaining pancreas is completely torn off the stomach wall. A percutaneous wound drainage is visible within the cavity. B The endoscopist inserts a polyurethane foam sponge into the cavity by a rat tooth grasping forceps. Endoscopic vacuum therapy (EVT) is then established by a vacuum pump which applies continuous suction to the sponge through a 16Fr catheter. C Partial view over the large retrogastral necrotic wound cavity containing percutaneous wound drainages (day 3 of EVT). D Wound cavity on day 16 of ongoing EVT and after direct endoscopic necrosectomy (DEN). Granulation tissue can be seen on the cavity walls. E PGD orifice with view into the wound cavity on day 20 of ongoing EVT. A first cycle of EVT (23 days) did not achieve effective reduction in cavity size. After discontinuation of EVT a second EVT cycle was launched 22 days later. Following another 15 days of EVT, the cavity size was eventually sufficiently small to discontinue EVT. F Complete closure of the PGD six weeks later