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

Abstract

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.

Risk Factors for Anastomotic Leakage: A Retrospective Cohort Study in a Single Gastric Surgical Unit

“…Several investigators have discussed how to prevent and manage esophagojejunostomy leakage. 32 33 34 …”

Self-Expanding Biodegradable Stents for Postoperative Upper Gastrointestinal Issues

“…In stable patients in whom conservative therapy has failed, endoscopic stenting is a valid treatment option for acute leaks, together with adequate drainage. 16 Stent placement can reduce the time from procedure to starting oral intake, morbidity, and duration of hospital stay compared with surgical intervention. Stents may also facilitate correction of the sleeve axis in cases of gastric twisting.…”

Retrospective analysis of the effects of continuous intraluminal aspiration on postoperative intestinal fistulas

“…However, complications, such as moderate, medium, or serious chest pain, bleeding, stent folding, pneumomediastinum, esophago-tracheal fistula, obstruction of the stent with food, and tracheal pressure have been reported after placing stents in the GI system [27][28][29].…”