Self-expandable metal stents for the treatment of benign upper GI leaks and perforations

Swinnen, Johan; Eisendrath, Pierre; Rigaux, Johanne; Kahegeshe, Liliane; Lemmers, Arnaud; Moine, Olivier Le; Devière, Jacques

doi:10.1016/j.gie.2010.12.019

Cited by 200 publications

(126 citation statements)

References 31 publications

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“…Endoscopy can define whether intrathoracic leakage is secondary to gastric conduit necrosis, conduit staple line dehiscence, or esophagogastric anastomosis dehiscence. Insertion of an esophageal stent across the leakage region is the most popular and effective method to seal leaks and avoid surgery, with the use of temporary fully covered SEMS being well documented in various report series (19)(20)(21). Migration rate may be explained by the fact that stents used are not designed specifically for the indication of esophageal leakage or fistula.…”

Section: Discussionmentioning

confidence: 99%

“…All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, 10 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] vs. 48 days , p = 0.228 and 12 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21] vs. 20 days , p = 0.374) (Fig. 1).…”

Section: Sems Placement and Adverse Eventsmentioning

confidence: 99%

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Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

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Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation.Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks.Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal.Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days.Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.

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Section: Discussionmentioning

confidence: 99%

Section: Sems Placement and Adverse Eventsmentioning

confidence: 99%

Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

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“…The success rates of endoscopic SEMS placement in the published literature range from 40 to 80% 10. After stent placement some patients can tolerate a fluid diet if a complete seal has been obtained, and while optimal duration of placement may vary, stents can generally be removed within 2–6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic modalities for upper gastrointestinal leaks, fistulae and perforations

Talbot

Yee

Saxena

2015

ANZ Journal of Surgery

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BackgroundEndotherapy techniques are a recent addition to the suite of non‐surgical and minimally invasive strategies to manage patients with perforations, leaks and fistulae. The emergency nature of these conditions and the heterogeneity of pathologies encountered create difficulties when trying to select appropriate tools in these complex situations. The purpose of this article is to review experience at a tertiary academic centre, describe the various endoscopic tools available and the situations where they can be considered for use.MethodsSingle‐centre series and review of the published literature.ResultsOf 64 patients, 57 were successfully treated using endoscopic therapy, with surgery used only to provide drainage and suture fully covered metal stents in place to prevent migration.DiscussionSelection of an appropriate endotherapy or stent for a patient with an oesophago‐gastric perforation or fistula requires an understanding of the anatomy and physiology underlying the patient's presentation and an understanding of the strengths and weaknesses of the available methods. Standard surgical principles of drainage, avoidance of distal obstruction and nutrition remain central to successful outcomes. A combination of surgical and endoscopic treatments may reduce the number of required treatments and can provide the ability to anchor fully covered stents to prevent them from migrating.

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“…It was found that staple line supporting materials have no effect in preventing leaks (3)(4)(5). Negative leakage tests, either intraoperative or early postoperatively, do not necessarily mean that a leak will not occur (6). Our routine practice is using an intraoperative leak test with methylene blue and use supportive sutures especially in the proximal area.…”

Section: Discussionmentioning

confidence: 99%

“…Success rates of 83-94% were reported usually in patients who were detected in the first ten days, in the abscence of generalized peritonitis and severe sepsis, while in cases with late diagnosis the rate was decreased down to 50%. In the series of 29 cases by Himpens et al, the fistula closed in 19 patients after the first stent placement and in 5 patients after the second stent (6)(7)(8)(9). Therefore, the early decision to place a stent is accepted as the most important factor in success.…”

Section: Discussionmentioning

confidence: 99%

Treatment of sleeve gastrectomy leak with an endoscopic stent

Özgüç

Narmanlı

Duman

2014

UCD

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Laparoscopic sleeve gastrectomy is used increasingly for obesity treatment. The most important complications of this procedure are bleeding and staple line leak. In this article, a 44-year-old female patient who developed a leak at the gastro-oesophageal junction following a revision laparoscopic sleeve gastrectomy is presented. The leak was recognized by computerized tomography and fluoroscopy that were performed during endoscopy. A fully expandable covered stent was inserted to the leak site. The stent was removed endoscopically after three weeks and the fistula healed completely. Early use of stents is an effective treatment method in leaks that have developed after sleeve gastrectomy.Key Words: Sleeve gastrectomy, staple line leak, oesophageal stent INTRODUCTIONLaparoscopic sleeve gastrectomy (LSG) is increasingly being applied in the surgical treatment of morbid obesity in recent years. As compared to methods such as gastric bypass or biliopancreatic diversion, laparoscopy is easy to apply and does not cause a major change in body physiology, successful results both in the short and medium term follow-up are the most important factors in this increase. The overall complication rate of LSG is reported as 0-24%, staple line leakage rate as 0 to 5.3% and the mortality rate as 0.39% (1, 2).Both the diagnosis and treatment of these leaks differ from other leaks. Early surgery, radiological drainage, stents, sutures, clip application, and various methods like tissue adhesive and t-tube external drainage have been defined in its treatment. In this case report, a patient who developed a leak following a secondary obesity surgery and was treated by endoscopic stenting alone was presented along with the literature. CASE PRESENTATIONA female patient with a body mass index (BMI) of 39.1 (length: 1.59, weight: 99) was admitted to hospital for obesity surgery due to weight gain. The patient previously underwent a laparoscopic gastric banding six years ago, but the band had been removed with open surgery one year later due to band infection. After removal of the gastric band, the patient stated rapid weight gain. She did not have any concomitant disease. Her physical examination was unremarkable except a midline supra-umbilical incision and port-site scars. The patient was planned to undergo LSG.The operation was performed in the French position, with the surgeon standing between the legs. The pneumoperitoneum was created by the open approach. Two 15 mm, one 10 mm, and one 5 mm ports and a 30 0 camera were used. There were intra-abdominal adhesions secondary to previous abdominal operations. All adhesions were separated by an ultrasonic dissector (Harmonic®, EthiconJohnson&Johnson). The greater curvature was dissected free of its vessels. The sleeve gastrectomy was completed by using five gold cartridges (Echolon Flex TM 60 mm, Ethicon-Johnson & Johnson), over a 42 F dilator, approximately 4 cm proximal to the pylorus. 2/0 silk serosal sutures were placed over the proximal staple lines. A leak test was performed with meth...

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Self-expandable metal stents for the treatment of benign upper GI leaks and perforations

Cited by 200 publications

References 31 publications

Self-expanding metal stents in postoperative esophageal leaks

Self-expanding metal stents in postoperative esophageal leaks

Endoscopic modalities for upper gastrointestinal leaks, fistulae and perforations

Treatment of sleeve gastrectomy leak with an endoscopic stent

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