Placing vacuum sponges in esophageal anastomotic leaks — how we do it

Endoluminal vacuum sponge therapy has dramatically improved the treatment of anastomotic leaks in esophageal surgery. However, the blind insertion of vacuum sponge kits like Eso-Sponge® via an overtube and a pusher can be technically difficult.

We therefore insert our sponges under direct visual control by a nonstandard “piggyback” technique that was initially developed for the self-made sponge systems preceding these commercially available kits.

Using this technique, we inserted or changed 56 Eso-Sponges® in seven patients between 2018 and 2023. Apart from one secondary sponge dislocation, no intraprocedural complications were encountered. One patient died due to unrelated reasons. In all others, the defects healed and they were dismissed from the hospital. Long-term follow-up showed three strictures that were successfully treated by dilatation.

We conclude that sponge placement via piggyback technique is a fast, safe, and successful alternative to the standard method of insertion.