Stent placement for benign esophageal leaks, perforations, and fistulae: a clinical prediction rule for successful leakage control

Halsema, Emo E. van; Kappelle, Wouter; Weusten, Bas L.; Lindeboom, Robert; Henegouwen, Mark I. van Berge; Fockens, Paul; Vleggaar, Frank P.; Spaander, Manon C.W.; Hooft, Jeanin E. van

doi:10.1055/s-0043-118591

Cited by 30 publications

(13 citation statements)

References 37 publications

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“…Early endoscopic intervention, once the leak was diagnosed, also had a trend for better outcome. Some of these predictions were similar to the prediction rule proposed by van Halsema et al, 13 whereby the success of SEMS placement for the esophageal leak decreased with larger leak size, elevated C-reactive protein, leaks at the level of the carina, and leaks with fistulas. Clustering the clinical presentations, using prediction rules, and adopting strategies that prevent various AEs could increase the success of endoscopic management of the leaks, thereby making it the first choice to manage postsurgical AEs.…”

supporting

confidence: 81%

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

Buttar

2021

Gastrointestinal Endoscopy

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supporting

confidence: 81%

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

Buttar

2021

Gastrointestinal Endoscopy

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“…Stent-related adverse effects include stent migration (with FCSEMS) and tissue ingrowth (with PCSEMS), requiring a stent-in-stent technique for definitive SEMS retrieval [81]. A retrospective cohort with calculation of a predictor rule identified patients with iatrogenic perforation as having a higher probability of obtaining successful treatment with SEMS, compared to those with fistulas [87]. Recently OTS clips have been used for esophageal stent fixation [89].…”

Section: Treatment: Esophagusmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

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“…To identify patients who may benefit from esophageal stent placement, van [120]. In the validation cohort, the sensitivity and specificity for a 70 % predicted probability of clinical success were 33 % and 89 %, respectively.…”

Section: Leaks Fistulas and Perforationsmentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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Stent placement for benign esophageal leaks, perforations, and fistulae: a clinical prediction rule for successful leakage control

Abstract: This prediction rule, consisting of four clinical predictors, could identify patients with esophageal leaks who were likely to benefit from or fail on stent therapy. The prediction rule can support clinical decision-making when the predicted probability of success is ≥ 70 % or ≤ 50 %.

Cited by 30 publications

References 37 publications

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

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