Management of Postoperative Esophageal Leaks With the Polyflex Self-Expanding Covered Plastic Stent

Langer, Felix B.; Wenzl, E.; Prager, Gerhard; Salat, Andreas; Miholic, J; Mang, Thomas; Zacherl, Johannes

doi:10.1016/j.athoracsur.2004.07.006

Cited by 191 publications

(139 citation statements)

References 31 publications

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“…14 Recently, a good outcome with low morbidity and mortality has been reported for treating benign oesophageal ruptures and leaks with temporary placement of a fully (FSEMS) or partially (PSEMS) covered self-expanding metal stent or a self-expanding plastic stent (SEPS). [15][16][17][18][19][20] Stents were found to be able to effectively seal oesophageal leaks or ruptures and allow healing of the oesophageal wall, particularly when concurrent adequate drainage of fluid collections in the mediastinum or pleural cavity is performed. The main drawbacks of stent placement are stent migration and tissue in-or overgrowth, both of which necessitate a repeat intervention.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

263

232

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Summary Background Placement of self‐expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs. Methods A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Results Twenty‐five studies, including 267 patients with complete follow‐up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent‐related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in‐ and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68]. Conclusions Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6–8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self‐expanding plastic stents and fully covered self‐expanding metal stents) and, to a minor degree, on expected risk of tissue in‐ or overgrowth (partially covered self‐expanding metal stents).

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Section: Discussionmentioning

confidence: 99%

“…26 (92) 20 (61) 58 (94) 2 (12) 2 (12) 3 (13) 4 (14) 6.1 35 (85) 9 (18) Total* 267 137 (51) 66 (25) 46 (17) 9 (4) 8 (3) 10.5…”

Section: (98)unclassified

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

263

232

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“…Leakage is curable by tissue recovery and granulation in most cases, and intractable esophagocutaneous fistula rarely develops. Intractable fistulas require more aggressive treatment, such as covered stents [19,20], primary closure and vascularized pedicle tissue flaps [7,21,22]. Covered stent insertion into the cervical esophagus often causes strong pharyngeal discomfort or stent migration.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Sternocleidomastoid Flap Repair for Cervical Anastomotic Leakage after Esophageal Reconstruction

Nakajima

Satomura²,

Takahashi³

et al. 2014

Dig Surg

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Background/Aims: The purpose of this study was to investigate the effectiveness of sternocleidomastoid (SCM) flap repair for anastomotic leakage after esophagectomy. Methods: A refractory cutaneous fistula from the gastric stump developed in 8 patients with esophageal cancer who underwent esophagogastric anastomosis after esophagectomy. All patients underwent SCM flap repair. The cutaneous fistula was removed and resutured. The sternal head of the left SCM was dissected from the manubrium of the sternum and sutured onto the repaired gastric stump. Results: The operative duration was 80-220 min (median, 120 min). The amount of intraoperative bleeding ranged from 5 to 182 g (median, 15 g). The absence of recurrent anastomotic leakage was confirmed after the SCM flap repair in every patient. Oral intake was initiated 7-15 days (median, 10 days) after the repair operation without discomfort. Conclusions: SCM flap repair is an effective and minimally invasive treatment method for cervical anastomotic leakage after esophageal reconstruction. This method may be considered in patients with refractory leakage of the gastric stump after staple anastomosis. i 2014 S. Karger AG, Basel

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“…Die Einlage von selbstexpandierenden Stents stellt sicherlich die am weitesten verbreitete Methode zur Behandlung von Anastomosenleckagen dar [13,14,15,16,17,18,19,20,21,22,23]. Es kommen sowohl komplett beschichtete Metallstents (fig.…”

Section: Stentanlageunclassified

Endoskopische Therapie von Nahtinsuffizienzen des Ösophagus

Wedemeyer

2012

Visc Med

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Hintergrund: Nahtinsuffizienzen stellen eine gefürchtete Komplikation nach Operationen an der Speiseröhre dar, die mit hoher Morbidität und Mortalität vergesellschaftet sind. Methoden: Die Einlage komplett beschichteter Stents stellt die am häufigsten eingesetzte Methode zur Behandlung ösophagealer Leckagen dar. Eine neue endoskopische Therapiemodalität besteht mit der endoskopischen Vakuumschwammtherapie. Hierbei macht man sich die positiven Effekte des vakuumassistierten Verschlusses (Vacuum-Assisted Closure, V.A.C.), der eine etablierte Therapiemodalität zur Behandlung ausgedehnter infizierter Hautdefekte darstellt, zunutze. Durch neue Entwicklungen haben auch Clips (insbesondere der «Over-the-Scope-Clip», OTSC) wieder eine Bedeutung beim Verschluss von ösophagealen Nahtinsuffizienzen erhalten. Ergebnisse: Mit diesen endoskopischen Techniken lassen sich Nahtinsuffizienzen des Ösophagus in über 80% der Fälle erfolgreich verschließen. Schlussfolgerung: Endoskopische Techniken stellen eine geeignete Methode zum Verschluss ösophagealer Leckagen dar und konnten daher in den letzten 10 Jahren die chirurgische Revision weitestgehend verdrängen

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Management of Postoperative Esophageal Leaks With the Polyflex Self-Expanding Covered Plastic Stent

Cited by 191 publications

References 31 publications

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Effectiveness of Sternocleidomastoid Flap Repair for Cervical Anastomotic Leakage after Esophageal Reconstruction

Endoskopische Therapie von Nahtinsuffizienzen des Ösophagus

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