Self-expanding metal stents in postoperative esophageal leaks

Abstract

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.

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

“…To comprehensively analyze the risk factors of anastomotic leak, first of all, it is emphasized that a precise and scrupulous surgical technique plays a decisive role in the healing of anastomotic tissue. Precise surgical operation needs to ensure firm and stable tissue closure, good blood supply to the stomach or other organs replacing the esophagus and targeted treatment of anastomotic tension 3–7 . At present, gastric conduit, especially the thin conduit replacing the esophagus, has been accepted by more and more surgeons.…”

“…The principle of self expandable metallic stent (SEMs) in the treatment of gastrointestinal fistula is to use the released stent to support the tube wall and to block the defect, so as to achieve physical isolation and promote the healing of the leak. With the popularization of SEMs in clinical practice, more and more successful cases have been reported, but many stent‐related complications have also been reported, the most common of which are stent‐related bleeding, stent displacement, and lateral abscess of fistula, etc 22–24 . Some scholars have reviewed the treatment experience of 15 patients with tracheal fistula and found that five were secondary to stent.…”

Adequate Management of Postoperative Complications after Esophagectomy: A Cornerstone for a Positive Outcome

“…In the case of an AL with a larger defect than what a clip can treat, SEMS with adequate CT-Scan-guided drainage of the paraesophageal hole can close the defect and ensure oral feeding. Following an easy placement, the SEMS usually needs up to 24 h to fully expand [ 33 ]. On the other hand, some teams such as ours are more prone to use the EVT as a first step approach.…”

Caustic esophageal stricture from diagnosis untill cure

“…Endoscopy plays an important role in the treatment of caustic esophageal strictures. Caustic stricture is often complex and difficult to dilate [10] . Early esophageal dilatation can be done after 3 weeks of caustic ingestion.…”