Year 2015 / Volume 107 / Number 10
Original
Fully covered metal stents for the treatment of leaks after gastric and esophageal surgery

608-613

DOI: 10.17235/reed.2015.3765/2015

Alberto Fernández, Víctor González-Carrera, Carlos González-Portela, Amalia Carmona, Manuel de-la-Iglesia, Santiago Vázquez,

Abstract
Objective: The use of fully covered metal stents (FCMS) for the treatment of benign conditions is increasing. The aim of our study was to assess the efficacy of FCMS in the management of post-operative leaks after gastric or esophageal surgery. Material and methods: During a three year period (2011-2013), patients who underwent a surgery related with esophageal or gastric cancer and developed a postoperative anastomotic leak treated with FCMS were prospectively included. Results: Fourteen patients were included (11 men, 3 women), with median age of 65 years. Placement of at least one stent was achieved in 13 patients (93% of cases), with initial closure of the leak in 12 of these 13 cases (92.3%). A final success (after removal of the stent) could be demonstrated in 9 cases (69.2%, intention to treat analysis); stent failed only in one case (7.7%) and there were 3 patients (23.1%) not evaluated because death before stent retrieval (not related with the endoscopic procedure). One stent were used in 9 cases (69.2%), and two in 4 (30.8%). Migration was observed in two cases (15.3%). There were no major complications related with the use of stents. There were no complications related with retrieval. Conclusions: The placement of FCMS to achieve the leak closure after esophageal or gastric surgery is an effective and probably safe alternative feasible with minor risks.
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References
1. Ikeguchi M, Oka S, Goymo Y, et al. Postoperative morbidity and mortality after gastrectomy for gastric carcinoma. Hepatogastroenterology 2001;48:1517-20
2. Lang H. Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leak in a serie of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000;26:168-71
3. Nowakowski P, Ziaja K, Ludyga T, et al. Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula. Dis Esophagus 2007;20:358-60
4. Biere SS, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophaguectomy for cancer: a systematic review and meta-analysis. Dig Surg 2011;28:29-35
5. Saluja SS, Ray S, Pal S, et al. Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck. J Gastrointestinal Surg 2012;16:1287-95
6. Briel JW, Tamhankar AP, Hagen L, et al. Prevalence and risk factors for ischemia, leak and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 2004;198:536-41
7. Rodella L, Laterza E, De Manzoni G, et al. Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy 1998;30:453-6
8. García-Moreno JL, Suárez Grau JM, Gómez Bravo MA, et al. Closure of gastrocutaneous fistula using endoscopic biological glue injection. Rev Esp Enferm Digest 2007;99:676-7
9. Evrard S, Le Moine O, Lazaraki G, et al. Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc. 2004;60:894-900
10. Gelbmann CM, Ratiu NL, Rath HC, et al. Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy. 2004;36:695-9
11. Hünerbein M, Stroszczynski C, Moesta KT, et al. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg. 2004;240:801-7.
12. Schubert D, Scheidbach H, Kuhn R, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61:891-6
13. Langer FB, Wenzl E, Prager G, et al. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg. 2005;79:398-403
14. Radecke K, Gerken G, Treichel U. Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc. 2005;6:812-8
15. Freeman RK, Ascioti AJ, Wozniak TC. Postoperative esophageal leak management with the Polyflex esophageal stent. J Thorac Cardiovasc Surg. 2007;133:333-8
16. Al-Haddad M, Craig CA, Odell J, et al. The use of self-expandable plastic stents for non-malignant esophago-pleural fistulas. Dis Esophagus. 2007;20:538-41.
17. Ott C, Ratiu N, Endlicher E, et al. Self-expanding Polyflex plastic stents in esophageal disease: various indications, complications, and outcomes. Surg Endosc. 2007;21:889-96
18. Pennathur A, Chang AC, McGrath KM, et al. Polyflex expandable stents in the treatment of esophageal disease: initial experience. Ann Thorac Surg. 2008;85:1968-72
19. Leers JM, Vivaldi C, Schäfer H, et al. Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc. 2009;23:2258-62
20. Tuebergen D, Rijcken E, Mennigen R, et al. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current imitations. J Gastrointest Surg. 2008;12:1168-76
21. Fischer A, Thomusch O, Benz S, et al. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg. 2006;81:467-72
22. Johnsson E, Lundell L, Liedman B. Sealing of esophageal perforation or ruptures with expandable metallic stents: a prospective controlled study on treatment efficacy and limitations. Dis Esophagus. 2005;18:262-6
23. Wadhwa RP, Kozarek RA, France RE, et al. Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc. 2003;58:207-12
24. Doniec JM, Schniewind B, Kahlke V, et al. Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy. 2003;35:652-8.
25. Siersema PD, Homs MY, Haringsma J, et al. Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc. 2003;58:356-61
26. Babor R, Talbot M, Tyndal A. Treatment of upper gastrointestinal leaks with a removable, covered, self-expanding metallic stent. Surg Laparosc Endosc Percutan Tech. 2009;19:e1-4
27. Amrani L, Ménard C, Berdah S, et al. From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of "stent-guided regeneration and re-epithelialization". Gastrointest Endosc. 2009;69:1282-7
28. Salminen P, Gullichsen R, Laine S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc. 2009;23:1526-30
29. Han XW, Li YD, Wu G, et al. New covered mushroom-shaped metallic stent for managing anastomotic leak after esophagogastrostomy with a wide gastric tube. Ann Thorac Surg. 2006;82:702-6
30. Buscaglia JM, Ho S, Sethi A, et al. Fully covered self-expandable metal stents for benign esophageal disease: a multicenter retrospective case series of 31 patients. Gastrointest Endosc. 2011;74:207-11
31. Wagh MS, Forsmark CE, Chauhan S, et al. Efficacy and safety of a fully covered esophageal stent: a prospective study. Gastrointest Endosc. 2012;75:678-82
32. Senousy BE, Gupte AR, Draganov PV, et al. Fully covered Alimaxx esophageal metal stents in the endoscopic treatment of benign esophageal diseases. Dig Dis Sci. 2010;55:3399-403
33. Eloubeidi MA, Lopes TL. Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans. Am J Gastroenterol. 2009;104:1374-81
34. Bakken JC, Wong Kee Song LM, de Groen PC, et al. Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases. Gastrointest Endosc. 2010;72:712-20
35. Wilson JL, Louie BE, Farivar AS, et al. Fully covered self-expanding metal stents are effective for benign esophagogastric disruptions and strictures. J Gastrointest Surg. 2013;17:2045-50
36. Rajan PS, Bansal S, Balaji NS, et al. Role of endoscopic stents and selective minimal access drainage in oesophageal leaks: feasibility and outcome. Surg Endosc. 2014;28:2368-73
37. Sharaiha RZ, Kim KJ, Singh VK, et al. Endoscopic stenting for benign upper gastrointestinal strictures and leaks. Surg Endosc. 2014;28:178-84
38. Roy-Choudhury SH, Nicholson AA, Wedgwood KR, et al. Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol. 2001;176:161-5
39. Fernandez A, Vila JJ, Vazquez S, et al. Self-expanding plastic stent for the treatment of post-operative esophago-jejuno anastomosis leak. A case series study. Rev Esp Enferm Dig 2010;102:704-10
40. Hirdes MM, Vleggaar FP, Van der Linde K, et al. Esophageal perforation due to removal of partially covered self-expanding metal stents placed for a benign perforation or leak. Endoscopy. 2011;43:156-9
41. Hirdes MM, Siersema PD, Houben MH, et al. Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents. Am J Gastroenterol. 2011;106:286-93
42. van Boeckel PG, Dua KS, Weusten BL, et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol. 2012;29;12:19.
43. Gangloff A, Lecleire S, Di Fiore A, et al. Fully versus partially covered self-expandable metal stents in benign esophageal strictures. Dis Esophagus. 2014 Aug 29. doi: 10.1111/dote.12260.
44. Van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the esophagus. Aliment Pharmacol Ther 2011;33:1292-301
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Fernández A, González-Carrera V, González-Portela C, Carmona A, de-la-Iglesia M, Vázquez S, et all. Fully covered metal stents for the treatment of leaks after gastric and esophageal surgery. 3765/2015


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Publication history

Received: 13/03/2015

Accepted: 02/06/2015

Online First: 23/06/2015

Published: 25/09/2015

Article revision time: 80 days

Article Online First time: 102 days

Article editing time: 196 days


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