Eso-SPONGE® – Endoluminal vacuum therapy for the treatment of anastomotic insufficiencies and perforations in the upper GI tract

In a 55-year-old male patient with squamous cell carcinoma of the distal third of the esophagus, an abdomino-thoracic esophagectomy with gastric tube reconstruction and end-to-end esophagogastrostomy (hand-sewn) was performed following neoadjuvant radiochemotherapy. On the 5th postoperative day, there was an increase in infection parameters. An endoscopic control examination revealed an anastomotic insufficiency affecting approximately ¼ of the anastomotic circumference at a distance of 25 cm from the dental arch. Endoscopically, an approximately 8 cm deep wall defect was found. During the same examination, the first placement of an Eso-SPONGE® in the insufficiency cavity was performed. The following film recordings show the second Eso-SPONGE® change.

The Eso-SPONGE® treatment set consists of an open-pore polyurethane sponge, which is introduced via an overtube and pusher, redirected transnasally, and then connected to an adjustable medical pump. To prepare for the therapy, unpack the set components; if necessary, the drain of the sponge can already be threaded through the pusher. Prepare sterile hydrogel, saline or Ringer's solution, a gastric tube Charrière 16, and various clamps.

Before using the Eso-SPONGE®, perform an endoscopic examination with measurement of the wound cavity. Slip the overtube over the endoscope (lubricate with gel or silicone spray) and insert under visual guidance to the end of the insufficiency cavity – the endoscope serves as a guide rail. Hold the overtube in position and carefully withdraw the endoscope.