Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks

Abstract

<b><i>Introduction:</i></b> Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. <b><i>Case Report:</i></b> Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL.Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. <b><i>Discussion/Conclusion:</i></b> SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.

Treatment of a staple-line leak after laparoscopic sleeve gastrectomy using an esophagoduodenal Niti-S Mega-stent

“…Endoluminal stenting is commonly used for staple-line leaks after LSG. Mega-stent offers complete bridging between esophagus and the duodenum, overcoming self-expandable metal stents’ limitations and increasing treatment success 1 2 3 4 5 .…”

Luminal and Extraluminal Applications of Endoscopic Stenting: A Bright Future for Gastroenterology

“…Sometimes endoscopists need to innovate and think outside the box to overcome complex and particular situations. For instance, Brito et al [11] presented a case series describing the application of Niti-S esophageal mega-stent in 2 patients with anastomotic leaks after oncologic surgery. Both cases achieved leak resolution after 2 weeks without adverse events.…”