Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy

Kauer, W. K. H.; Stein, Hubert J.; Dittler, H. J.; Siewert, J R

doi:10.1007/s00464-007-9504-5

Cited by 145 publications

(101 citation statements)

References 14 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%

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

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

264

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%

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

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

264

232

View full text Add to dashboard Cite

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“…Anastomotic leakages also cause high mortality and morbidity after upper gastrointestinal surgery. Particularly after an esophagectomy, anastomotic leakage occurs at a rate of 4-30% and has a high mortality rate [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Until recently, the approach for managing postoperative anastomotic leaks was mainly surgical or radiological percutaneous drainage, as well as antibiotic therapy, bowel rest, parenteral nutrition and, if necessary, diversion [1,2,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, self-expandable stents, which were already used for the palliative treatment modality of malign obstructions in the gastrointestinal tract, began to be used for treatment of gastrointestinal anastomosis leakages [5][6][7][8]. Today, endoscopic self-expanded covered stent placement is well accepted as an effective treatment modality for anastomotic leakage in the gastrointestinal tract, and its usage is gradually increasing [2,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Today, endoscopic self-expanded covered stent placement is well accepted as an effective treatment modality for anastomotic leakage in the gastrointestinal tract, and its usage is gradually increasing [2,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Aday¹,

Duman²,

Deđer³

et al. 2017

Arch Med Sci Civil Dis

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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.

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Complications of Esophageal Resection

Paul

Altorki

2009

Complications in Cardiothoracic Surgery

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Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy

Abstract: Stent implantation in patients with thoracic anastomotic leaks after esophagectomy is an easily available and effective treatment option with low morbidity, but stent migration does occur.

Cited by 145 publications

References 14 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

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

Complications of Esophageal Resection

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