Abstract
Purpose
The purpose of this study is to analyze the outcomes of the self-expanding covered metallic stent (SECMS) therapy in the management of the postoperative anastomotic leaks that seen after total gastrectomy–esophagojejunostomy (EJ) operations.
Materials and methods
Contrast radiography and endoscopy revealed EJ fistulas in 14 patients. SECMSs were implanted both fluoroscopically and endoscopically to seal fistulas. Postoperative fistula diagnosis times, postoperative covered stent implantation times, primary success rates, clinical success rates, postinterventional oral feeding beginning times, reduction of the drainage from the surgical drains, procedure-related mortality–morbidity, and mortality related with factors other than the procedure were noted.
Results
Technical success rate was 100 %. Clinical success rate was 79 %. Reduction of the fluid from surgical drains was observed in all patients. There were no procedure-related mortality. Recurrent fistula was observed in two patients (14 %) at the third and fifth day after the intervention. In one patient (7 %), stent dislocation was observed at the 10th day after the intervention. Non procedure-related mortality was 21 %. No anastomotic stricture, no in-stent stenosis was observed during the follow up period(11.09 ± 3.21 months).
Conclusion
From the above results we concluded that SECMS treatment for EJ fistulas is a safe, effective and technically easy procedure.
Similar content being viewed by others
References
Csendes A, Díaz JC, Burdiles P, et al. (1990) Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma. Hepatogastroenterology 37:174–177
Schubert D, Scheidbach H, Kuhn R, et al. (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61:891–896
Tuebergen D, Rijcken E, Mennigen R, et al. (2008) Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg 12:1168–1176
Eubanks S, Edwards CA, Fearing NM, et al. (2008) Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg 206:935–938 (discussion 938–939)
Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ (2010) Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg 89:931–936 (discussion 936–937)
Doglietto GB, Papa V, Tortorelli AP, et al. (2004) Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial. Arch Surg 139:1309–1313
Rodella L, Laterza E, De Manzoni G, et al. (1998) Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy 30:453–456
Roy-Choudhury SH, Nicholson AA, Wedgwood KR, et al. (2001) Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 176:161–165
Nowakowski P, Ziaja K, Ludyga T, et al. (2007) Self-expandable metallic stents in the treatment of post-esophagogastrostomy/postesophagoenterostomy fistula. Dis Esophagus 20:358–360
Sampaio JA, Waechter FL, Pereira-Lima J, et al. (2003) Successful treatment of esophagojejunal disconnection after total gastrectomy by insertion of a covered self-expandable esophageal metallic stent. Gastrointest Endosc 58:453–456
Cho YP, Lee DH, Jang HJ, et al. (2003) Leakage of jejunal end of roux limb after total gastrectomy: management with a placement of a covered metallic stent: case report. J Korean Med Sci 18:437–440
Curcio G, Mocciaro F, Tarantino I, et al. (2010) Self-expandable metal stent for closure of a large leak after total gastrectomy. Case Rep Gastroenterol 4:293–297
Lang H, Piso P, Stukenborg C, Raab R, Jähne J (2000) Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26:168–171
Bracale U, Marzano E, Nastro P, et al. (2010) Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24:2475–2479
Scurtu R, Groza N, Otel O, Goia A, Funariu G (2005) Quality of life in patients with esophagojejunal anastomosis after total gastrectomy for cancer. Rom J Gastroenterol 14:367–372
Qadeer MA, Dumot JA, Vargo JJ, Lopez AR, Rice TW (2007) Endoscopic clips for closing esophageal perforations: case report and pooled analysis. Gastrointest Endosc 66:605–611
Langer FB, Wenzl E, Prager G, et al. (2005) Management of postoperative esophageal leaks with the polyflex self-expanding covered plastic stent. Ann Thorac Surg 79:398–403
Gelbmann CM, Ratiu NL, Rath HC, et al. (2004) Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 36:695–699
Conflicts of interest
Drs. Fahrettin Kucukay M.D.,Rıza S. Okten M.D., Erkan Parlak M.D., Selcuk Disibeyaz M.D., Yusuf Ozogul M.D., E Birol Bostanci M.D., and Olcer M.D. have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kucukay, F., Okten, R.S., Parlak, E. et al. Self-expanding covered metallic stent treatment of esophagojejunostomy fistulas. Abdom Imaging 38, 244–248 (2013). https://doi.org/10.1007/s00261-012-9895-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-012-9895-1