Novel Endoscopic Stent for Anastomotic Leaks after Total Gastrectomy Using an Anchoring Thread and Fully Covering Thick Membrane: Prevention of Embedding and Migration

Abstract

PurposeThe endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management.Materials and MethodsThe effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016.ResultsThe technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3–30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3–35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18–49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement.ConclusionsA benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

Effectiveness of a Novel Covered Stent without External Thread Fixation for Anastomotic Leakage after Total or Proximal Gastrectomy for Gastric Cancer

“…The rates of complete leakage healing after stent placement range from 70% to 85.7% in patients who develop esophageal anastomotic leakage after esophagectomy or gastrectomy [12][13][14]. When assessed by the first stent placement, the success rates slightly decrease to 51-80% [12][13][14].…”

“…The rates of complete leakage healing after stent placement range from 70% to 85.7% in patients who develop esophageal anastomotic leakage after esophagectomy or gastrectomy [12][13][14]. When assessed by the first stent placement, the success rates slightly decrease to 51-80% [12][13][14]. Further, despite the high success rates of leakage healing, stent migration is frequent, occurring in 25-61% of the patients depending on the anastomosis type [12,13].…”

“…Additional endoscopic treatments are needed to improve leakage healing in patients with large anastomotic leakage. Among endoscopic modalities, fully covered self-expanding metallic stents (SEMSs) are highly effective for esophageal anastomotic leakage after gastrectomy, with treatment success rates of 70-85.7% [12][13][14]. However, stent migration can occur in up to 61% of patients who underwent esophagojejunostomy [12], and thus, external fixation through the nose of SEMS using a silk thread (thread-fix stent) was developed.…”

“…However, stent migration can occur in up to 61% of patients who underwent esophagojejunostomy [12], and thus, external fixation through the nose of SEMS using a silk thread (thread-fix stent) was developed. This successfully eliminated the risk of stent migration [14,15]. Nonetheless, the thread-fix stent is associated with prolonged discomfort and longer hospitalization than the SEMS without external fixation due to the external fixation state during leakage healing.…”

Insertion of Transnasal Abscess Drainage Tube, Decompression Tube, and Jejunal Nutrition Tube Under Fluoroscopy to Treat Esophagojejunal Anastomotic Fistula After Gastrectomy for Gastric Cancer

“…Currently, there is no consensus on the best treatment for esophagojejunal stula. Treatments include fasting and nil water through mouth with complete parenteral nutritional support, mucosal protective agents, gastrointestinal decompression, percutaneous thoracic drainage tube placement, surgery-related drainage tube placement, surgical repair, esophageal stents, titanium clips, and endoluminal vacuum treatment (EVT) [1,3,[5][6].…”