Perioperative management - Eso-SPONGE® – Endoluminal vacuum treatment in staple line failure and perforations of the upper GI tract - general and visceral surgery
You have not purchased a license - paywall is active: to the product selection
- 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
Preoperative diagnostic work-up
- 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