Closure of Benign Leaks, Perforations, and Fistulas With Temporary Placement of Fully Covered Metal Stents

Orive-Calzada, Aitor; Calderón-García, Ángel; Bernal-Martínez, Antonio; Díaz-Roca, Ana Belén; Barrio, Irantzu; Cabriada, José Luis; Orive-Cura, Victor

doi:10.1097/sle.0b013e318293c4d8

Cited by 21 publications

(17 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ultimately, three of the patients who received an additional Hanaro CCI stent and all three patients who received another type of stent died with the new stent in situ because of persisting intrathoracic sepsis, while one of the patients who received an additional Hanaro CCI stent eventually underwent surgical leak repair because of persisting intrathoracic sepsis. Finally, four patients died in the hospital with the first stent in situ after a median (range) of 19 days because of persisting intrathoracic sepsis ( n = 3) and preexisting bowel ischemia ( n = 1), respectively, without any further interventions (see flowchart in Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula

et al. 2015

View full text Add to dashboard Cite

Upper gastrointestinal perforations, fistula, and anastomotic leaks are severe conditions with high mortality. Temporary endoscopic placement of fully covered self-expanding metal stent (fSEMS) has emerged as treatment option. Stent migration is a major drawback of currently used stents. Migration is often attributed to a relatively too small stent diameter as esophageal stents were initially intended for the treatment of strictures. This study aimed to investigate the safety and efficacy of a large-diameter fSEMS for treatment of these conditions. Data were retrospectively collected from patients who received this stent in the Netherlands between March 2011 and August 2013. Clinical success was defined as sufficient leak closure after stent removal as confirmed by endoscopy or X-ray with oral contrast without surgical intervention or placement of another type of stent. Adverse events were graded according a standardized grading system. Stent placement was performed in 34 patients for the following indications: perforation (n = 6), anastomotic leak (n = 26), and fistula (n = 2). Technical success rate was 97% (33/34). Clinical success rate was 44% (15/34) after one stent and 50% (17/34) after an additional stent. There were no severe adverse events and stent-related mortality. The overall adverse event rate was 50% (all graded 'moderate'). There were 14 (41%) stent migrations (complete n = 8, partial n = 6). Other adverse events were bleeding (n = 2) and aspiration pneumonia (n = 1). Reinterventions for failure of the large-diameter fSEMS were placement of another type of fSEMS (n = 4), surgical repair (n = 3), or esophagectomy (n = 1). Eleven patients (32%) died in-hospital because of persisting intrathoracic sepsis (n = 10) or preexistent bowel ischemia (n = 1). This study suggests that temporary placement of a large-diameter fSEMS for the treatment of upper gastrointestinal perforations, fistula, and anastomotic leaks is safe in terms of severe adverse events and stent-related mortality. The larger diameter does not seem to prevent stent migration.

show abstract

Section: Resultsmentioning

confidence: 99%

Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula

et al. 2015

View full text Add to dashboard Cite

show abstract

“…[20][21][22][23] The largest and most recent studies including only post-surgical leaks or providing subgroup analysis of post-surgical leaks are listed in Table 1. 18,[23][24][25][26][27] These studies show a pooled success rate of 76%, a very encouraging result putting in consideration the low rate of serious adverse events, and a great improvement in comparison to conventional non-endoscopic approaches. It is to be noted though that many of these patients eventually healed after the insertion of several stents, thus the failure of healing after removing the first stent should not be considered an endoscopic failure, further attempts should be sought unless there is frank deterioration of the patient's general condition and need for urgent surgical intervention.…”

Section: Endoscopic Techniques For Leak Closure Stentsmentioning

confidence: 89%

“…The Achilles tendon of stents is the high rate of migration, studies assessing FCSEMS report migration in 20% to 84%, with the largest series reporting 53%. 18,23,[25][26][27][28][31][32][33] Migration necessitates re-intervention for stent positioning or exchange, and may be associated with serious adverse events such as perforation or necessity for surgical extraction. 23,25,26 Many attempts have been made to overcome this problem.…”

Section: Endoscopic Techniques For Leak Closure Stentsmentioning

confidence: 99%

Endoscopic management of postsurgical leaks

Shehab

2016

Int J Gastrointest Interv

View full text Add to dashboard Cite

Postsurgical leaks are a major complication with significant mobidity and mortality. Conventional conservative and surgical approaches are highly morbid with limited success. Over the last decade several endoscopic techniques have proved effective with a favorable safety profile. Nevertheless, most data still come from retrospective series, and many studies included heterogenous patient groups pooling complex surgical leaks with minor endoscopic perforations. This review focuses on the endoscopic management of the more difficult postsurgical leaks. Stents and over-the-scope clips are currently the key endoscopic techniques for leak closure, but emerging techniques such as vacuum sponge therapy and endoscopic internal drainage have proved to be at least as effective. The current trend is to use these different techniques interchangeably or simultaneously rather than assuming a single standardized approach.

show abstract

“…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%

Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

View full text Add to dashboard Cite

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.

show abstract

Closure of Benign Leaks, Perforations, and Fistulas With Temporary Placement of Fully Covered Metal Stents

Cited by 21 publications

References 43 publications

Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula

Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula

Endoscopic management of postsurgical leaks

Self-expanding metal stents in postoperative esophageal leaks

Contact Info

Product

Resources

About