Indication
Treatment for oesophageal anastomotic leakage and perforations
Eso-SPONGE is indicated for patients with an anastomotic leaks or perforations in the oesophageal area.
More than half of all oesophageal perforations are iatrogenic (caused by medical examination or treatment) but other causes include Boerhaave’s Syndrome, trauma, foreign body ingestion or malignancy.
Oesophageal cancer is the 13th most common cancer in the UK, accounting for 3% of all new cancer cases in 2015. Oesophagogastric anastomotic leaks are the most feared surgical complications following resection of oesophageal cancers.
Oesophogeal leakages are difficult to treat as you have to control sepsis, close the leakage and eradicate the cavity, Eso-SPONGE® enables you to do all of these.
Product
Eso-SPONGE® is an Endoluminal Vacuum Therapy (E-VAC) system for the treatment of anastomosis insufficiency or perforation within the Upper GI tract. It is an open-pore polyeurethane sponge with a 100cm drainage tube designed to sit in the cavity and when connected to a vacuum pump, drain, clean and decrease the cavity.
Eso-SPONGE® has been available in Europe since July 2014 and numerous clinical investigations including over 200 patients have been performed using E-VAC to treat anastomotic leakages occurring after oesophageal cancer resection.
Eso-SPONGE® is a minimally invasive method of treating anastomotic leakage, when the sponge is in the cavity it continually drains it, controls the infection, cleans and debrides the cavity, promotes granulation of healthy tissue and mechanically reduces the size of the cavity.
How to use Eso-SPONGE®
When a patient presents with an anastomotic insufficiency or perforation an Upper GI surgeon or endoscopist would investigate and measure the wound cavity with a flexible endoscope. An overtube is introduced into the insufficiency hole, using the endoscope as a guide. Eso-SPONGE® is covered with sterile hydrogel and introduced into the overtube.
The Eso-SPONGE® is pushed down using the pusher to the indicated mark, where the sponge will be at the end of the overtube. Holding the pusher and pulling the overtube, the sponge will unfold into the insufficiency hole. The pusher and overtube can them be removed together.
The position of the sponge would then be checked endoscopically and appropriate correction can take place using endoscopic forceps.
A gastric tube is inserted through the nose and brought out of the mouth, it is then connected to the Eso-SPONGE® tube, pulling the gastric tube together with the drainage tube back through the nose so that it’s connected trans nasally.
The drain is connected via a Y-piece to the hose of an adjustable medical pump (with suction capabilities between 50 and 125mmHg).
This system must be changed every 48 – 72 hours and a new sponge inserted to continue the treatment. The vacuum is connected constantly and drainage is 24/7, only stopping during changes.
Sponges must be changed in this time frame as they are porous and will become clogged over time, if left too long they will become increasingly difficult to remove and change while no longer providing the treatment effectively to help the patient.