Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage

Lee, Kee Myung; Shin, Sung Jae; Hwang, Jae Chul; Yoo, Byung Moo; Cheong, Jae Youn; Lim, Sun Gyo; Kim, Jae Keun; Cho, Yong Kwan; Han, Sang Uk; Lee, Sang-Rim; Kim, Jin Hong

doi:10.1016/j.gie.2010.02.052

Cited by 15 publications

(19 citation statements)

References 10 publications

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“…Precise implantation of self-expandable metal stents reportedly can be monitored by transnasal endoscopy 10 11 . However, that technique demands a second investigator and the availability of a transnasal gastroscope.…”

Section: Discussionmentioning

confidence: 99%

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Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

et al. 2017

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Background and study aims Road Map (RM) fluoroscopy is a radiological technique that enables visualization of anatomic structures using image subtraction at peak opacification. RM fluoroscopy has never previously been evaluated for use in endoscopy. The aim of this study was to evaluate the usefulness of RM in guiding endoscopic intervention in the esophagus. Patients and methods This was a monocentric observational trial of consecutive patients with esophageal strictures in a university hospital. Twenty-seven investigations using RM were performed in 24 patients undergoing esophageal endoscopy. Indications for the procedure were balloon dilatation (n = 7 including 2 pneumatic balloon dilatations for treatment of achalasia), bougie dilatation (n = 7) and diagnostic endoscopy (n = 1). In addition, 12 stents, 7 partially covered and 5 fully covered, were placed using RM as a guide for determination of stent length and diameter. Stents were deployed under RM guidance. Results In all procedures, RM successfully guided the intervention. Endoscopic control endoscopy confirmed adequate stent placement in all cases. Conclusion RM allows permanent and accurate radiographic imaging of stenoses and esophageal anatomic changes. It is an easy and safe method of guiding endoscopic interventions that require radiological imaging.

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Section: Discussionmentioning

confidence: 99%

“…However, that technique demands a second investigator and the availability of a transnasal gastroscope. In addition, use of transnasal gastroscopes is of particular use for stent positioning in proximal stenosis, where precise positioning of the stent is mandatory 11 .…”

Section: Discussionmentioning

confidence: 99%

Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

et al. 2017

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“…It was concluded that covered stent placement for a period of 6–8 weeks was safe and effective for benign esophageal ruptures and anastomotic leaks to heal [ 17 ]. An article from Lee and coworkers reported that healing of leaks after endoscopic placement of covered stents in patients with anastomotic leaks occurred in 4 out of 6 patients after 2 weeks of stent indwelling [ 18 ], while an article from Schubert and coworkers reported that a complete closure of the leakage after silicone-covered, self-expanding polyester stents in patients with thoracic esophageal anastomotic leaks was achieved in 11 of 12 patients after stent removal with a median stent retrieval time of 4 weeks (range 2–8 weeks) [ 9 ]. On the other hand, Eubanks and coworkers reported that healing of leaks after endoscopic placement of covered stents in patients with anastomotic leaks after bariatric surgery was achieved at a mean of 33 days [ 19 ], while Edwards and coworkers reported that acute anastomotic leaks after Roux-en-Y bypass had completely healed at a median of 44 days when self-expanding polyester stents were used [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although stent migration remains a common problem when using fully covered metal stents in patients with postoperative anastomotic leaks, several novel fixation procedures were reported to eliminate migration of the fully covered metal stents, such as a stent fixation technique with a bridle which was created by delivering umbilical tape through each nostril [ 22 ] or through a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Self-Expandable Metal Stent Placement for Closure of a Leak after Total Gastrectomy for Gastric Cancer: Report on Three Cases and Review of the Literature

Raimondo

Sinagra

Facella

et al. 2014

Case Reports in Gastrointestinal Medicine

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In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible. We report here three cases of placement of a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, NC, USA) in patients who underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric adenocarcinoma. The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients. In fact, in the treatment of leakage after total gastrectomy, plastic stents and totally covered metallic stents may not adhere sufficiently to the esophagojejunal walls and, as a result, migrate beyond the anastomosis. However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

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“…Lee et al . describe an anchoring technique using a silk thread to link the stent to the patient's earlobe transnasally, which may prevent dislocation from unobstructed lesions 60 …”

Section: Therapeutic Optionsmentioning

confidence: 99%

Current concepts in the management of leakages after esophagectomy

2012

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Esophagectomy is a high-risk procedure that, despite advances over past years, is still associated with high morbidity and mortality. Anastomotic insufficiency is a devastating surgical complication as it is linked to postoperative morbidity and is the main cause for postoperative mortality. It can lead to sepsis and necessitate re-operation, further increasing morbidity and mortality through additional complications brought on by the repeated invasive procedures. However, not all anastomotic leakages entail such a critical course of events and can be sufficiently dealt with by less invasive measures. As a consequence, the approach to anastomotic leakage must be carefully selected in order to minimize additional procedure-related risks while ensuring adequate therapy. In this setting, less invasive treatments such as esophageal stents and clips, application of vicryl plugs in combination with fibrin glue, and endoscopic insertion of vacuum sponges, have emerged in recent years and become a viable alternative in the management of certain leakages. This review presents current algorithms for detection, classification and treatment of leakages after esophagectomy.

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Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage

Cited by 15 publications

References 10 publications

Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

Self-Expandable Metal Stent Placement for Closure of a Leak after Total Gastrectomy for Gastric Cancer: Report on Three Cases and Review of the Literature

Current concepts in the management of leakages after esophagectomy

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