Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS)

Aryaie, Amir; Singer, Jordan L.; Fayezizadeh, Mojtaba; Lash, Jon; Marks, Jeffrey M.

doi:10.1007/s00464-016-5005-8

Cited by 55 publications

(37 citation statements)

References 31 publications

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“…This figure compares favorably to the general data for esophageal surgery, which has a mortality rate ranging from 5 to 50% of patients [27]. All deaths occurred in patients treated with PCSEMS, but no statistical difference with FCSEMS was found.…”

Section: Discussionsupporting

confidence: 72%

“…In 2 recent retrospective analysis of case series of patients with esophageal leaks treated with SEMS, the success rates have ranged from 69 to 90% [26,27]. The slight difference with our results may be due to chance, since both of these reports have significantly smaller simple size, or confounding by operator preferences of patient selection for the procedure.…”

Section: Discussioncontrasting

confidence: 62%

“…Even though this event is usually more frequent with PCSEMS [9,30,31], other authors [27,32,33] have described similar complications after extraction of FCSEMS. These tears were treated with high dose PPI and sucralfate, and healed without any significant clinical consequence.…”

Section: Discussionmentioning

confidence: 85%

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Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

et al. 2018

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Background/Aims: The study aimed to evaluate the effectiveness and safety of self-expanding metal stents (SEMS) in the management of post-surgical esophageal leaks. Methods: Retrospective data of consecutive patients with a post-surgical esophageal leak treated by means of a metal stent between January 2008 and December 2014 at the Humanitas Research Hospital (Milan, Italy) were extracted from a prospectively maintained register of SEMS used for benign indications, such as post-surgical benign esophageal strictures and/or leaks. The primary outcome of the study was to assess the rate of successful leak closure and to identify the variables associated with its achievement. As a secondary outcome, we evaluated the overall safety of SEMS placement and the efficacy and safety for different types of SEMS in this specific setting of patients. Leak resolution was documented with endoscopic and/or imaging studies. In the case of leak persistence, further attempts of esophageal stenting were carried out at the discretion of both endoscopists and surgeons. Results: A total of 49 patients were included in the study (men 41 of 49, 83.7%, mean age 62.4 ± 11.9). One patient was excluded from analysis, because of death 1 day after stent insertion due to worsening of pre-existing mediastinitis. A total number of 82 stents were placed (mean number of stents per patient: 1.7) in 49 patients: 35 patients (71.4%) received a partially covered SEMS (PCSEMS) as the first stent positioned, while the remaining 14 (28.6%) received a fully covered SEMS (FCSEMS); but 1 patient (2%) died following stent insertion; therefore, data regarding therapeutic success were available for 48 patients. Stents were left in place for a mean period of 21.9 ± 15.2 days. Leak closure after the first stent placement was achieved in 22 of 48 (45.8%) patients. Of the 26 patients with failure of index stent placement, 18 patients underwent further stenting attempts (69.2%), and secondary closure of leak was achieved in 7 (38.9%) of these 18 patients. Thus, the overall success rate was 60.5% (29 of 48). On the basis of stent type, the success rate was 57.1% (8 of 14) for FCSEMS and 64.7% (22 of 34) for PCSEMS. Logistic regression analysis did not find any significant association between successful leak closure and analyzed variables. Overall mortality was 13.0%. Complication rate was 38.8% (19 of 49 patients). Conclusion: The use of SEMS is an effective and safe option for post-surgical esophageal leaks, with no evidence of any significant influence of stent type on outcome.

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Section: Discussionsupporting

confidence: 72%

Section: Discussioncontrasting

confidence: 62%

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Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

et al. 2018

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“…[11] Although the technical success rate of stent placement is nearly 100%, stent migration rate was reported to be higher compared with that of SEMS placement for malignant strictures (20–40%) because of the absence of stenosis maintaining the stent position. [3,9,17] In the present study, stent migration was absent. To prevent stent migration, we used Shim technique.…”

Section: Discussionsupporting

confidence: 44%

“…In recent years, the fully covered SEMS has been used for the treatment of benign conditions such as perforation, leaks, and strictures. [3,9] Other than the fully covered SEMS, the self-expandable plastic stent and partially covered SEMS can also be used. The efficacy of different stent types is not significantly different.…”

Section: Introductionmentioning

confidence: 99%

Full covered self-expandable metal stents for the treatment of anastomotic leak using a silk thread

Choi

Kang²,

Kim³

et al. 2017

Medicine

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To evaluate the safety and effectiveness of fixation of the fully covered self-expandable metal stent (SEMS) placement using a silk thread for complete closure of an anastomotic leak. An anastomotic leak is a life-threatening complication after gastrectomy. Although the traditional treatment of choice was surgical re-intervention, an endoscopic SEMS can be used alternatively.During the study period, we retrospectively reviewed consecutive patients who received a modified covered SEMS capable of being fixed using a silk thread (Shim technique) due to an anastomotic leak after gastrectomy to prevent stent migration. Demographic data, stent placement and removal, clinical success, time to resolution, and complications were evaluated.A total of 7 patients underwent fully covered SEMS with a silk thread placement for an anastomotic leak after gastrectomy to treat gastric cancer. The patients’ mean age was 71.3 ± 8.0 years. Man sex was predominant (85.7%). All patients’ American Society of Anesthesiologists (ASA) scores were between I and III. Total gastrectomy was performed in 5 patients (71.4%) and proximal gastrectomy was performed in 2 patients (28.6%). The time between gastrectomy and stent insertion was 22.3 ± 11.1 days. The size of the leaks was 27.1 ± 11.1 mm. Technical success and complete leak closure were achieved in all patients. Stent migration was absent. All stents were removed between 4 and 6 weeks. Delayed esophageal stricture was found in 1 patient (14.2) and successfully resolved after endoscopic balloon dilation.For an anastomotic leak after gastrectomy, fully covered SEMS placement with a silk thread is an effective and safe treatment option without stent migration. The stent extraction time between 4 and 6 weeks was optimal without severe complications.

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Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning

Hodgens

Bueno

2019

Multidisciplinary Approaches to Common Surgical Problems

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Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS)

Cited by 55 publications

References 31 publications

Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

Full covered self-expandable metal stents for the treatment of anastomotic leak using a silk thread

Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning

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