From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of “stent-guided regeneration and re-epithelialization”

Amrani, L.; Ménard, Charles; Berdah, Stéphane; Emungania, Olivier; Soune, Phillipe Ah; Subtil, C.; Brunet, Christian; Grimaud, Jean–Charles; Barthet, Marc

doi:10.1016/j.gie.2008.09.043

Cited by 67 publications

(32 citation statements)

References 16 publications

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“…closure with clips or sutures, sealing with biological glue and sealing with stent placement. 13 Endoscopic stent placement is an effective treatment for malignant dysphagia in a palliative setting. 14 Recently, a good outcome with low morbidity and mortality has been reported for treating benign oesophageal ruptures and leaks with temporary placement of a fully (FSEMS) or partially (PSEMS) covered self-expanding metal stent or a self-expanding plastic stent (SEPS).…”

Section: Discussionmentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

259

232

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Summary Background Placement of self‐expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs. Methods A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Results Twenty‐five studies, including 267 patients with complete follow‐up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent‐related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in‐ and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68]. Conclusions Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6–8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self‐expanding plastic stents and fully covered self‐expanding metal stents) and, to a minor degree, on expected risk of tissue in‐ or overgrowth (partially covered self‐expanding metal stents).

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Section: Discussionmentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

259

232

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“…The stents were removed after 5 weeks and two months respectively, without residual leak. So, the authors proposed a new concept of ''stent-guided mucosal healing'': a covered stent might act as a support to guide tissue regeneration and re-epithelialization alongside the external membrane [124].…”

Section: Stentmentioning

confidence: 99%

Endoscopic “rescue” treatment for gastrointestinal perforations, anastomotic dehiscence and fistula

Dabizzi

Ceglie²,

Baig

et al. 2016

Clinics and Research in Hepatology and Gastroenterology

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“…Covered SEMS are being successfully used for the treatment of postoperative gastrointestinal fistulas [44]. However, covered stents almost uniformly migrate from the colon, even when fixation techniques are used [45].…”

Section: Future Perspectivesmentioning

confidence: 99%

Update on the Indications and Use of Colonic Stents

Bonin

Baron

2010

Curr Gastroenterol Rep

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Self-expandable metal stent (SEMS) placement is a minimally invasive option for achieving acute colonic decompression in obstructed colorectal cancer. Colorectal stenting offers nonoperative, immediate, and effective colon decompression and allows bowel preparation for an elective oncologic resection. Patients who benefit the most are highrisk surgical patients and candidates for laparoscopic resection with complete obstruction, because emergency surgery can be avoided in more than 90% of patients. Colonic stent placement also offers effective palliation of malignant colonic obstruction, although it carries risks of delayed complications. When performed by experienced endoscopists, the technical success rate is high with a low procedural complication rate. Despite concerns of tumor seeding following endoscopic colorectal stent placement, no difference exists in oncologic long-term survival between patients who undergo stent placement followed by elective resection and those undergoing emergency bowel resection. Colorectal stents have also been used in selected patients with benign colonic strictures. Uncovered metal stents should be avoided in these patients, and fully covered stents are associated with high risk of migration. Patients with benign colonic stricture with acute colonic obstruction who are at high risk for emergency surgery can gain temporary relief of obstruction after SEMS placement; the stent can be removed en bloc with the colon specimen at surgery. This article reviews the techniques and indications of SEMS placement for benign and malignant colorectal obstructions.

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From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of “stent-guided regeneration and re-epithelialization”

Cited by 67 publications

References 16 publications

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Endoscopic “rescue” treatment for gastrointestinal perforations, anastomotic dehiscence and fistula

Update on the Indications and Use of Colonic Stents

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