Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents

Dai, Yiyang; Gretschel, Stephan; Dudeck, O.; Rau, Beate; Schlag, Peter M.; Hünerbein, M.

doi:10.1002/bjs.6648

Cited by 74 publications

(86 citation statements)

References 37 publications

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“…In more complex or extensive leakage a delayed reconstruction after diversion with a cervical esophagostomy may be required. However, surgical reintervention is associated with high morbidity and mortality (16)(17)(18) and prolonged intensive care unit and hospital stays, particularly in patients with a delayed diagnosis and mediastinal and pleural contamination. Endoscopy can define whether intrathoracic leakage is secondary to gastric conduit necrosis, conduit staple line dehiscence, or esophagogastric anastomosis dehiscence.…”

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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“…Some studies [24][25][26] concluded that stent placement has been shown to be an excellent treatment in patients with mediastinal abscess in GEAL, while others [27] revealed that certain problems might be associated with stent placement and removal: insufficient closure of the leaks, stent migration and development of strictures after stent removal, severe complications such as bleeding and food blockage, and hard removal because of the growth of granulation tissue. Han et al [7] treated the patients of mediastinal abscess with stent placement and nasaloesophagus drainage.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Guo²,

Chen³

et al. 2012

The British Journal of Radiology

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Objective The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). Methods From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients’ nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. Results The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49±0.42 g dl−1) to the post-enteral feeding (3.58±0.47 g dl−1) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). Conclusion The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.

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“…Auch hier sind die fehlende Standardisierung und der Mangel an prospektiven Studien wesentliche Faktoren, die die Einschätzung der Verfahren so schwierig machen [35]. Polyflex-Kunststoffstents [4,38,39] zeigen bei kleinen Fallserien von 5-22 Patienten eine Initialverschlussrate von 40-95% sowie einen definitiven Therapieerfolg bei 80-100%. Die Hauptkomplikation ist die Migration der Stents, die in bis zu 23% der Fälle auftritt.…”

Section: Therapie Bei Anastomoseninsuffizienzen Nach öSophagus- Und Munclassified

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

Werner¹,

Sauer

2013

Visc Med

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Hintergrund: Anastomoseninsuffizienzen stellen die schwerwiegendste septische Komplikation nach viszeralchirurgischen Eingriffen dar. Neben der chirurgischen Therapie sind zunehmend endoskopische Behandlungsoptionen möglich. Methode: Literaturübersicht. Ergebnisse: Therapieoptionen von Anastomoseninsuffizienzen sind abhängig von der klinischen Symptomatik, der Art der Anastomose, der Defektgröße, den lokalen Gewebeverhältnissen sowie dem Zeitpunkt der Diagnose. Bei einer Nekrose oder Minderdurchblutung der Viszeralorgane müssen diese operativ reseziert werden. Prinzipiell sind alle operativen Revisionseingriffe auch laparoskopisch durchführbar. Bei erhaltener Gewebeperfusion können die Leckagen lokal übernäht oder endoskopisch verschlossen werden. Die Ergebnisse für die Stenttherapie nach Ösophagus- und Magenresektionen sind für moderne Stents sehr Erfolg versprechend. Im Gegensatz dazu sind die Ergebnisse der endoskopischen Stenttherapie bei Insuffizienz nach kolorektalen Eingriffen enttäuschend; dafür steht hier mit der Schwammtherapie eine vielversprechende endoskopische Alternative zur Verfügung. Schlussfolgerung: Die aktuellen Daten zeigen, dass neue laparoskopische und endoskopische Optionen zur Therapie von Anastomoseninsuffizienzen bestehen, die jedoch noch in prospektiven und randomisierten Studien evaluiert werden müssen.

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Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents

Abstract: In combination with effective drainage, self-expanding plastic stents are an option for the treatment of oesophageal anastomotic leaks, and may reduce leak-related morbidity and mortality.

Cited by 74 publications

References 37 publications

Self-expanding metal stents in postoperative esophageal leaks

Self-expanding metal stents in postoperative esophageal leaks

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

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