Perioperative management - Eso-SPONGE® – Endoluminal vacuum treatment in staple line failure and perforations of the upper GI tract

• Endoscopic vacuum therapy with the Eso-SPONGE® system is suitable for the treatment of esophageal defects of all sizes, levels and in infectious conditions. It can be used at/as:

• • Esophageal staple line failure
  • Esophageal perforations (iatrogenic, foreign body, Boerhaave syndrome)
  • “Bridge-to-Surgery”: Vacuum therapy as a therapeutic option for sepsis control until definitive surgical defect repair

Paraesophageal wound cavities must be accessible by endoscopy!

Other diseases successfully treated with this technique to date:

• • Necrotizing pancreatitis (transgastric necrosectomy)
  • Staple line failure in pancreaticojejunostomy

Prophylactic placement of endoluminal sponges to protect fragile esophageal anastomoses is conceivable.

• Transmural esophageal defect with extensive necrosis, gangrene, and ischemia: Vacuum therapy as bridging option, at best
• Transmural defect with tracheobronchial fistula: technically impossible to establish a vacuum

Flexible endoscopy

• • Repeat daily when facing diagnostic uncertainties
  • Defect level = distance from dental arch
  • Size of defect estimated relative to inserted endoscope
  • Assessment of blood supply to the anastomosis/interposition graft and the local inflammation
  • Exploration of small defects with a small-bore nasal gastroscope: extraluminal wound cavity?

Contrast-enhanced computed tomography

• • Baseline and in the course of treatment to monitor the sponge position and drainage of the septic focus
  • Visualization of undrained pleural and mediastinal air and fluid retention as well as concomitant pulmonary complications