Eso-SPONGE™

A. Position the overtube inside the cavity leaving some space for the sponge to deploy, then place the sponge drain inside the pusher and introduce the hydrogel-impregnated sponge through the overtube.

B. Push the Eso-SPONGE to the mark with the pusher. The sponge is now at the end of the overtube (uncut sponge).

C. Keep pushing and Allow the sponge to expand in the leakage cavity. Use an endoscope to verify its position and adjust if necessary (only the bottom of the sponge must be visible), with endoscopic grasping forceps.

D. Use a CH16 nasogastric tube to place the drain in a transnasal position and then disconnect the gastric tube.

• The mean treatment duration time reported is less than 30 days. ^{1, 5, 7-8, 10-12, 14-17, 19-21}
• Early treatment is likely to achieve faster healing, shorter duration of treatment & hospital stay and less
  complications. ^{1, 5-8, 10}
• Promotes debridement, quick cleaning of the wound cavity.^{1-11, 13, 15, 17}

• The average rate of successful treatment with Eso-SPONGE has been reported to occur in 84% of patients. ^{1, 5-13}
• Likely to be superior to stent treatment and reduced need for surgical revision, and with less strictures ^{6, 8-9, 14}
• Contributes significantly to the reduction of morbidity and mortality of the patients ^{5-11, 13, 20}
• Promotes of granulation tissue ingrowth^{1-11, 13, 15-17, 19-21}
• If necessary, Eso-SPONGE™ can be combined with stent placement or operative revision for better control of the septic focus.^{1, 5-11, 13, 15,18, 20}

Some patients have higher risk of developing an anastomotic leakage after esophagectomy due existing conditions such as:

• Calcification or arteries ²²
• Heart failure, hypertension, renal insufficiency ²³
• Obesity ²⁴
• Diabetes ²³

• 12.3 % - 13.6 % leakage rate in Cervical anastomosis ^23,25
• 2.9 % - 9.3 % leakage rate in Thoracic anastomosis ^23,25

• Follow the insertion system as described for the treatment placing the end of the overtube passed the anastomosis site.
• Release the Eso-SPONGE, and pulled the drainage to position it at the anastomosis site.
• The drainage can be positioned transnasally.
• Connect the device to the recommended vacuum source.
• Apply a continuous negative pressure of 75 mmHg as previously described.
• Leave the sponge for 4 to 6 days and retire the sponge.

• Overtube (2 sizes available)
• Pusher
• Irrigation set
• Y-shaped connector
• Slide clamp