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Healing Occurs in Most Patients That Receive Endoscopic Stents for Anastomotic Leakage; Dislocation Remains a Problem

https://doi.org/10.1016/j.cgh.2010.12.010Get rights and content

Background & Aims

There is controversy about the best way to treat esophageal anastomotic leakage. We evaluated the effects of treatment with self-expanding metal stents in patients with esophageal anastomotic leakage after esophagectomy or gastrectomy for cancer.

Methods

We investigated outcomes and procedure-related complications of 115 patients who received endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy at a university hospital from 2004 to 2009. We also performed a systematic literature review on stent therapy and compared outcomes with that of other treatment regimens for esophageal anastomotic leakage.

Results

Among the 115 patients who received stents, the in-hospital mortality rate was 9% and complete anastomotic healing was achieved in 70% (95% confidence interval [CI], 64%–76%). Stent dislocation occurred in 53% of the patients (95% CI, 43%–62%), in all patients with esophagocolonostomy, in 61% with esophagojejunostomy, and in 49% with esophagogastrostomy. Three percent of patients (95% CI, 1%–5%) needed laparotomy to remove dislocated stents. Elective endoscopic stent removal was performed in 80% of the patients after a median of 54 days (range 17–427 d); 12% of these patients developed symptomatic anastomotic strictures after stent removal.

Conclusions

Anastomoses completely heal in 70% of patients that receive endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy. Stent therapy should be used in the management of patients with adequately perfused esophageal anastomotic leakage. However, stent dislocation remains a common problem after surgery.

Section snippets

Study Cohort

Between 2003 and 2009, there were 1296 patients who underwent esophagectomy or trans-hiatally extended gastrectomy for carcinomas of the esophagus or esophagogastric junction in the Department of Surgery at the Klinikum Rechts der Isar, Technische Universität München, as a national referral center for these tumor entities. In 115 patients (9%; 95% confidence interval [CI], 7.4%–10.5%), a fully covered self-expanding metal stent was placed endoscopically as the first treatment option for

Results

The median interval between surgery and diagnosis of anastomotic leakage with endoscopic stent placement was 8 days (range, 3–21 d).

Discussion

The concept of additional stent placement in the conservative management of esophageal anastomotic leakage after esophagectomy or gastrectomy provides the advantage of immediate leak occlusion, which allows early oral feeding, avoids further contamination of the mediastinum, and, finally, results in shorter hospital stays.12, 13, 14, 15, 16, 17, 18, 19 However, stent placement also forces the need for adequate perianastomotic drainage because stents not only stop further intestinal leakage to

References (27)

  • A. Sauvanet et al.

    Diagnosis and conservative management of intrathoracic leakage after oesophagectomy

    Br J Surg

    (1998)
  • A. Viste et al.

    Stomach cancer: a prospective study of anastomotic failure following total gastrectomy

    Acta Chir Scand

    (1987)
  • S. Griffin et al.

    Factors influencing mortality and morbidity following oesophageal resection

    Eur J Cardiothorac Surg

    (1989)
  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

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