Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula

Abstract

Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators.

Evidence-Based Recommendations on Upper Gastrointestinal Tract Stenting: A Report from the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy

“…Leaks were successfully closed in all patients and oral feeding was resumed 2 days after the procedure. Stent migration was observed in two patients 74. A case series reported the usefulness of SEMSs in patients ( n =12) with acquired benign tracheoesophageal fistulas.…”

Pooperacinio stemplės ir skrandžio ar stemplės ir plonosios žarnos jungties nesandarumo gydymas išsiplečiančiais stentais

“…Po išplėstinių stemplės ar skrandžio rezekcinių operacijų dėl onkologinių ligų stemplės ir skrandžio ar stemplės ir žarnos jungties nesandarumas yra grėsmingiausia pooperacinė komplikacija, pasireškianti iki 27 % [1] operuotų ligonių. Ji gali būti mirtina iki 9 % tokių ligonių [2].…”

Endoscopic management of postoperative fistulas and leaks

“…13,15,16 Postoperative leaks after esophagectomy occur in up to 35% of cases 17 and 4% to 27% after gastrectomy, carrying a mortality as high as 65%. 18,19 Intrathoracic leak following esophagectomy carries higher mortality compared to cervical leak 20 and if there is a delay in treatment for over 24 hours, mortality approaches as high as 50%. 21 Endoscopic closure of esophageal leaks was first demonstrated by Schubert et al 22 in which clips were used to treat smaller esophageal leaks.…”