Management of esophageal anastomotic leaks, perforations, and fistulae with self-expanding plastic stents

Abstract

In combination with effective interventional or surgical drainage, stenting is a viable option for the treatment of esophageal anastomotic leaks and perforations, but the success in tracheoesophageal fistula is limited.

Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

“…Due the risk of mediastinal contamination during endoscopy, it is recommended that esophageal stents be placed at time of initial endoscopic diagnosis. [30] The morbidity associated with endoscopic management and stenting extends to the required follow-up and often the need for repeat interventions. Serial surveillance chest radiography is required to monitor for stent migration, and when detected, repeat endoscopy is required to reposition the stent.…”

“…Dai and colleagues demonstrated that in their series, repeat stenting was necessary in 33 of 40 patients, the mean number of stents per patient was 3.2, and the mean time to healing was 30 days. [30] The principle advantage of endoscopic stenting is immediate coverage of the anastomotic defect with shorter time to oral intake. Freeman and colleagues demonstrated that 82% of patients were able to resume oral intake within 72 hours of stent placement.…”

A comprehensive approach to the management of acute endoscopic perforations (with videos)

“…In two studies, oral intake was initiated at approximately 3 days after covered stent placement for esophageal perforations. 71,72 We believe oral intake of liquids can be resumed on the fourth or fifth day. Surgical intervention is mandatory if endoscopic closure or stent diversion is not possible or is unsuccessful or in the setting of clinical deterioration despite endoscopic and percutaneous (see the following) intervention.…”

Closure of tracheoesophageal fistula with two‐layer tracheal‐esophagoplasty and tracheal advancement

“…However, success with this option is limited. 14 If the fistula does not respond to conservative measures, surgical closure may be necessary. Jacobs et al described a submucosal purse-string suture that had an 80% success rate in their 20 patients.…”