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Endoscopic vacuum-assisted therapy (EVAT) is a reliable treatment for endoscopically accessible abscesses and was recently described in the management of infected pancreatic pseudocyst (IPC) [1-4]. EVAT when performed in the region of the celiac trunk und portal venous system has, in theory, a higher risk of bleeding than when performed in other regions of the body. We treated a woman who had sepsis due to an IPC, chronic pancreatitis, and pronounced gastric varices by EVAT, but with a coated sponge. The treatment was generally performed as previously described [4]. After 1 week of endoscopic therapy the cyst was free of necrosis and we started EVAT. We adjusted the size of the sponge according to the local topography and wrapped the Endo-SPONGE (B. Braun, Melsungen, Germany) in one layer of Suprasorb CNP Drainage Film (Lohmann & Rauscher, Vienna, Austria), a double-layered film for vacuum therapy of wounds (• " Fig. 1 and UCTN-Unusual cases and technical notes E49 Wallstabe I et al. Endoscopic vacuum-assisted therapy of infected pancreatic pseudocyst using a coated sponge … Endoscopy 2012; 44: E49-E50

Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.