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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2014

01-01-2014

Endoscopic stenting for benign upper gastrointestinal strictures and leaks

Authors: Reem Z. Sharaiha, Katherine J. Kim, Vikesh K. Singh, Anne Marie Lennon, Stuart K. Amateau, Eun Ji Shin, Marcia Irene Canto, Anthony N. Kalloo, Mouen A. Khashab

Published in: Surgical Endoscopy | Issue 1/2014

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Abstract

Background

Self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) maybe used for the treatment of benign upper gastrointestinal (GI) leaks and strictures. This study reviewed our experience with stent insertions in patients with benign upper GI conditions.

Methods

Patients who underwent stent placement for benign upper GI strictures and leaks between March 2007 and April 2011 at a tertiary referral academic center were studied using an endoscopic database and electronic patient records. The technical success, complications, and clinical improvement after stent removal were compared according to type of stent. The outcomes measured were clinical response, adverse events, and predictors of stent migration.

Results

Thirty-eight patients (50 % male, mean age = 54 years, range = 12–82) underwent 121 endoscopic procedures. Twenty patients had stents placed for strictures, and 18 had stents placed for leaks. Stent placement was technically successful in all patients. The average duration of stent placement was 54 days (range = 18–118). Clinical improvement immediately after stent placement was seen in 29 of the 38 patients (76.3 %). Immediate post-procedure adverse events occurred in 8 patients. Late adverse events were seen in 18 patients. Evidence of stent migration occurred in 16 patients and was seen in 42 of the 118 successfully placed stents (35.5 %). Migration was more frequent with fully covered SEMS (p = 0.002). After stent removal, 27 patients were evaluable for long-term success (median follow-up time of 283 days, IQR 38–762). Resolution of strictures or leaks was seen in 11 patients (40.7 %). Predictors for long-term success included increasing age and if the stent did not cross the GE junction.

Conclusions

Placement of SEPS and SEMS for benign refractory strictures and fistulas has modest long-term clinical efficacy and is limited by a significant migration rate. Stent migration is common and frequent with fully covered SEMS compared to other types of stents, regardless of indication or location.
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Metadata
Title
Endoscopic stenting for benign upper gastrointestinal strictures and leaks
Authors
Reem Z. Sharaiha
Katherine J. Kim
Vikesh K. Singh
Anne Marie Lennon
Stuart K. Amateau
Eun Ji Shin
Marcia Irene Canto
Anthony N. Kalloo
Mouen A. Khashab
Publication date
01-01-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3150-x

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