Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 5/2014

01-05-2014

Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses

Authors: Jens Hoeppner, Birte Kulemann, Garbriel Seifert, Goran Marjanovic, Andreas Fischer, Ulrich Theodor Hopt, Hans-Jürgen Richter-Schrag

Published in: Surgical Endoscopy | Issue 5/2014

Login to get access

Abstract

Background

Anastomotic leakage of esophagogastric and esophagojejunal anastomoses is a severe complication after esophagectomy and gastrectomy associated with a high mortality. We conducted this non-randomized observational study to evaluate the outcomes and clinical effectiveness of covered self-expanding stents (CSESs) in treating esophageal anastomotic leakage.

Methods

From 2002 to 2013, consecutive patients with anastomotic leakage after esophagogastrostomy or esophagojejunostomy who received CSESs were analyzed concerning leakage characteristics, leakage sealing rate, success and failure rates of CSES treatment, stent-related complications, and mortality.

Results

In 35 patients, anastomotic leakage originating from 5 cervical esophagogastrostomies, 6 thoracic esophagogastrostomies, 12 mediastinal esophagojejunostomies and 12 abdominal esophagojejunostomies were treated with 48 CSESs (16 fully CSES, 32 partially CSES). Of 35 patients, 24 received one stent, 9 received two consecutive stents, and 2 received three consecutive stents. Stent-related complications occurred in 71 % of patients (25/35). The most frequent complications were leakage persistence (44 %) and stent dislocation (19 %). Sealing of the anastomotic leakage was achieved in 24 (69 %) patients after a median (range) stenting time of 19 (1–78) days. Sealing rates differed significantly with 20 % (cervical esophagogastrostomies), 50 % (thoracic esophagogastrostomies), 92 % (mediastinal esophagojejunostomies) and 67 % (abdominal esophagojejunostomies) of patients (p = 0.023). Moreover, clinical success rates differed among these groups (60 vs. 67 vs. 92 vs. 58 %; p = 0.247). Clinical failure of stent treatment was more likely to be recognized in early postoperative leakage (median postoperative day 3 vs. 8; p = 0.098) compared with successful treatment, whereas no difference for clinical success rates was found comparing leakage ≤10 versus >10 mm (68 vs. 64 %; p = 0.479).

Conclusion

CSESs are an effective treatment for anastomotic leakage in patients with esophagogastrostomies and esophagojejunostomies. Best results can be achieved in patients with anastomotic leakages following mediastinal esophagojejunostomy, and in leakages occurring after the very early postoperative phase.
Literature
1.
Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T et al (2012) Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg 16(9):1659–1665PubMedCrossRef
2.
Lang H, Piso P, Stukenborg C, Raab R, Jahne J (2000) Management and results of proximal anastomotic leaks in a series of 1,114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26(2):168–171PubMedCrossRef
3.
Turkyilmaz A, Eroglu A, Aydin Y, Tekinbas C, Muharrem Erol M, Karaoglanoglu N (2009) The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus 22(2):119–126PubMedCrossRef
4.
Cafarotti S, Cesario A, Porziella V, Leuzzi G, Vita ML, Meacci E et al (2013) Post esophagectomy anastomotic leaks: the role of the anastomotic location. Ann Ital Chir 84:137–141PubMed
5.
Lee S, Ahn JY, Jung HY, Lee JH, Choi KS, Kim DH et al (2013) Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc 27(11):4232–4240PubMedCrossRef
6.
Rodella L, Laterza E, De Manzoni G et al (1998) Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy 30(5):453–456PubMedCrossRef
7.
Loske G, Schorsch T, Müller C (2011) Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy 43(6):540–544PubMedCrossRef
8.
Infante M, Valente M, Andreani S, Catanese C, Dal Fante M, Pizzetti P et al (1996) Conservative management of esophageal leaks by transluminal endoscopic drainage of the mediastinum or pleural space. Surgery 119(1):46–50PubMedCrossRef
9.
Böhm G, Mossdorf A, Klink C, Klinge U, Jansen M, Schumpelick V et al (2010) Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue. Endoscopy 42(7):599–602PubMedCrossRef
10.
Schweigert M, Solymosi N, Dubecz A, Stadlhuber RJ, Muschweck H, Ofner D et al (2013) Endoscopic stent insertion for anastomotic leakage following oesophagectomy. Ann R Coll Surg Engl 95(1):43–47PubMedCrossRef
11.
van Boeckel PG, Dua KS, Weusten BL, Schmits RJ, Surapaneni N, Timmer R et al (2012) Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 12:19PubMedCentralPubMedCrossRef
12.
Freeman RK, Ascioti AJ, Giannini T, Mahidhara RJ (2012) Analysis of unsuccessful esophageal stent placements for esophageal perforation, fistula, or anastomotic leak. Ann Thorac Surg 94(3):959–964PubMedCrossRef
13.
Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O et al (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73(5):890–899PubMedCrossRef
14.
Fischer A, Bausch D, Richter-Schrag HJ (2013) Use of a specially designed partially covered self-expandable metal stent (PSEMS) with a 40-mm diameter for the treatment of upper gastrointestinal suture or staple line leaks in 11 cases. Surg Endosc 27(2):642–647PubMedCrossRef
15.
McKeown KC (1976) Total three-stage oesophagectomy for cancer of the oesophagus. Br J Surg 63(4):259–262PubMedCrossRef
16.
Orringer MB, Sloan H (1978) Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg 76(5):643–654PubMed
17.
Lewis I (1946) The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third. Br J Surg 34:18–31PubMedCrossRef
18.
Siersema PD, Homs MY, Haringsma J, Tilanus HW, Kuipers EJ (2003) Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc 58:356–361PubMedCrossRef
19.
Tuebergen D, Rijcken E, Mennigen R, Hopkins AM, Senninger N, Bruewer M (2008) Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg 12(7):1168–1176PubMedCrossRef
20.
Roy-Choudhury SH, Nicholson AA, Wedgwood KR, Mannion RA, Sedman PC, Royston CM et al (2001) Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 176(1):161–165PubMedCrossRef
21.
D’Cunha J, Rueth NM, Groth SS, Maddaus MA, Andrade RS (2011) Esophageal stents for anastomotic leaks and perforations. J Thorac Cardiovasc Surg 142(1):39.e1–46.e1
22.
Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T et al (2005) Management of postoperative esophageal leaks with the polyflex self-expanding covered plastic stent. Ann Thorac Surg 79:398–403PubMedCrossRef
23.
Gelbmann CM, Ratiu NL, Rath HC, Rogler G, Lock G, Schölmerich J et al (2004) Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 36:695–699PubMedCrossRef
24.
Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H (2003) Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy 35:652–658PubMedCrossRef
25.
Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F et al (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61(7):891–896PubMedCrossRef
26.
Dai Y, Chopra SS, Kneif S, Hünerbein M (2011) Management of esophageal anastomotic leaks, perforations, and fistulae with self-expanding plastic stents. J Thorac Cardiovasc Surg 141(5):1213–1217PubMedCrossRef
27.
Pallotta N, Baccini F, Corazziari E (1999) Contrast ultrasonography of the normal small bowel. Ultrasound Med Biol 25(9):1335–1340PubMedCrossRef
28.
Lee J, Huprich J, Kujath C, Ravi K, Enders F, Smyrk TC et al (2012) Esophageal diameter is decreased in some patients with eosinophilic esophagitis and might increase with topical corticosteroid therapy. Clin Gastroenterol Hepatol 10(5):481–486PubMedCrossRef
29.
Knoop H, Knoop U, Martini HC, Heining L, Wolf R, Ewig S et al (2012) Tracheal perforation by an oesophageal stent. Pneumologie 66(10):607–609PubMedCrossRef
30.
Crestanello JA, Deschamps C, Cassivi SD, Nichols FC, Allen MS, Schleck C et al (2005) Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 129(2):254–260PubMedCrossRef
31.
Schniewind B, Schafmayer C, Voehrs G, Egberts J, von Schoenfels W, Rose T et al (2013) Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc 27(10):3883–3890PubMedCrossRef
32.
Weidenhagen R, Hartl WH, Gruetzner KU, Eichhorn ME, Spelsberg F, Jauch KW (2010) Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg 90(5):1674–1681PubMedCrossRef
Metadata
Title
Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses
Authors
Jens Hoeppner
Birte Kulemann
Garbriel Seifert
Goran Marjanovic
Andreas Fischer
Ulrich Theodor Hopt
Hans-Jürgen Richter-Schrag
Publication date
01-05-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3379-4

Other articles of this Issue 5/2014

Surgical Endoscopy 5/2014 Go to the issue

OriginalPaper

International consensus on safe techniques and error definitions in laparoscopic surgery

OriginalPaper

Immersive training: breaking the bubble and measuring the heat

OriginalPaper

Ergonomic assessment of the French and American position for laparoscopic cholecystectomy in the MIS Suite

Review

Learning curve for transanal endoscopic microsurgery: a single-center experience

Dynamic Manuscript

Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer

OriginalPaper

Risk of developing metachronous colon neoplasm after polypectomy: comparison of one-stage versus two-stage polypectomy