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

The endoscopic vacuum therapy using the Eso-SPONGE® system is a suitable treatment method for esophageal defects of all sizes, heights, and infection situations. It can be used for/as:

• Anastomotic insufficiencies of the esophagus
• Esophageal perforations (iatrogenic, foreign body, Boerhaave syndrome)
• "Bridge-to-Surgery": Vacuum therapy as a treatment option for sepsis control until definitive surgical defect repair

Paraesophageal wound cavities must be endoscopically accessible!

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

• Transmural esophageal defect with extensive necrotization, gangrene, and ischemia: Vacuum therapy only as bridging
• Transmural defect with connection to the tracheobronchial system: Vacuum setup technically not possible

Flexible Endoscopy

• if findings are uncertain, repeat at daily intervals
• Defect height = distance from the dental arch
• Estimate the size of the defect in relation to the inserted endoscope
• Assessment of the blood supply to the anastomosis region/graft and the local inflammation situation
• Exploration of small defects using a small-caliber nasal gastroscope: extraluminal wound cavity?

Contrast-Enhanced Computed Tomography

• initially and during the course of treatment to monitor sponge positioning and focus sanitation
• Detection of possibly undrained pleural and mediastinal air and fluid collections as well as accompanying pulmonary complications