Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience

Abstract

A b s t r a c tIntroduction: Anastomotic leakage is an important and undesirable major complication after upper and lower gastrointestinal surgery. This complication can lead to significant morbidity and mortality and prolonged hospital stay. The objective of this study was to evaluate the safety and technical and clinical outcomes of temporary partially covered self-expandable metallic stent (PCSEMS) placement for treating anastomotic leaks after gastrointestinal tract surgery. Material and methods: Medical records of 9 patients who had undergone partial covered self-expandable esophageal or colonic stenting either for colorectal anastomotic leak or esophageal anastomotic leak in Kartal Kosuyolu Higher Specialty Training and Research Hospital between April 2012 and October 2015 were collected. Living patients were recalled for the policlinic follow-up and recent status was recorded. Results: The mean age was 57 (37-78) years. Six of the patients were male and 3 of them female. Stents were successfully placed in all patients in the fistula localization on the first attempt. Stent migration was encountered in 3 patients and restenting was performed in 2 of these patients. No complications were seen related to the indwelling stents. Stent treatment failure occurred in 2 of the 9 patients. The mean removal time of the stent was 43 (5-70) days and it was not possible to get the stent out in 1 patient. Conclusions: Endoscopic stenting is a minimally invasive and highly effective procedure that gives promise for the treatment of fistula after digestive surgery in the future.

Histologic recovery among children with celiac disease on a gluten-free diet. A long-term follow-up single-center experience

“…But this endoscopic method is not able to provide biopsy samples, so it could not be indicated for intestinal recovery assessment in gluten enteropathy. Gastrointestinal endoscopy is a minimally invasive and highly effective method [ 30 ], available for all age groups, capable of sampling intestinal tissue. Therefore it is the main tool indicated for assessment of histologic recovery in CD patients.…”

Effect of splenic flexure mobilization performed via medial-to-lateral and superior-to-inferior approach on early clinical outcomes in elective laparoscopic resection of rectal cancer.

“…Postoperative complications were classified based on the Clavien-Dindo classification [21]. Anastomotic leakage was defined as gas or fecal discharge from the incision line, vagina, or the drain tract, extravasation of contrast material and air bubbles around the anastomosis verified by rectal contrast-enhanced CT, and the presence of an anastomotic defect verified by laparotomy or rectal examination [22]. Evaluation of anastomotic stenosis was performed based on the presence of clinical suspicion.…”