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Surgical Endoscopy

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01-08-2013

Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital

Authors: Bart J. M. Leenders, Arnold Stronkhorst, Frans J. Smulders, Grard A. Nieuwenhuijzen, Lennard P. L. Gilissen

Published in: Surgical Endoscopy | Issue 8/2013

Abstract

Background

Anastomotic leakages are severe complications of upper gastrointestinal surgery with serious morbidity and mortality. Until recently, only abscess drainage was possible. Since 2007, removable and repositionable covered metal self-expandable stents (RReCoMSeS) have been used in our hospital to cover leaks.

Methods

Patients with postsurgical gastrointestinal leaks treated with RReCoMSeS between January 2007 and March 2010 were retrospectively evaluated and described.

Results

Twenty-six patients were treated with RReCoMSeS (totally covered Choo/Hanaro and partially covered Endoflex stents). Included patients had anastomotic leaks after esophagectomy (15) and bariatric surgery (11). Overall successful sealing of the leak occurred in 81 % (including multiple procedures). In total 33 RReCoMSeS were used (mean 1.3 stents and 1.7 procedures per patient). Twenty-one of 33 RReCoMSeS succeeded in sealing the leak (64 %). Migration occurred in 24 % RReCoMSeS, and 9 % disintegrated. One stent (3 %) caused a perforation.

Conclusions

RReCoMSeS are a safe alternative for treating postsurgical leaks in the upper gastrointestinal tract. In 81 % of patients and with 64 % of the inserted stents, leaks were sealed successfully, with few complications. Fewer stents per patient were needed thanks to their repositionability. Stent migration is a major problem.

Kauer WK, Stein HJ, Dittler HJ, Siewert JR (2008) Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc 22(1):50–53PubMedCrossRef

Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10(2):71–75PubMed

Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, van Raemdonck D (2002) Anastomotic complications after esophagectomy. Dig Surg 19(2):92–98PubMedCrossRef

Whooley BP, Law S, Alexandrou A, Murthy SC, Wong J (2001) Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg 181(3):198–203PubMedCrossRef

Griffin SM, Lamb PJ, Dresner SM, Richardson DL, Hayes N (2001) Diagnosis and management of a mediastinal leak following radical oesophagectomy. Br J Surg 88(10):1346–1351PubMedCrossRef

Eubanks S, Edwards CA, Fearing NM, Ramaswamy A, De la Torre RA, Thaler KJ, Miedema BW, Scott JS (2008) Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg 206(5):935–938PubMedCrossRef

Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5(4):469–475PubMedCrossRef

Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ (2008) Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 4(1):33–38PubMedCrossRef

Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, Matter I, Alfici R, Mahajna A, Waksman I, Shimonov M, Assalia A (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27(1):240–245PubMedCrossRef

10.

Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169(6):634–640PubMedCrossRef

11.

Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61(7):891–896PubMedCrossRef

12.

Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J (2005) Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 79(2):398–403PubMedCrossRef

13.

Salminen P, Gullichsen R, Laine S (2009) Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc 23(7):1526–1530PubMedCrossRef

14.

Johnsson E, Lundell L, Liedman B (2005) Sealing of esophageal perforation or ruptures with expandable metallic stents: a prospective controlled study on treatment efficacy and limitations. Dis Esophagus 18(4):262–266PubMedCrossRef

15.

Lee BI, Choi KY, Kang HJ, Kim BW, Choi H, Kim CW, Jeong JJ, Park SH, Chung IS, Kim JJ, Park SM (2006) Sealing an extensive anastomotic leak after esophagojejunostomy with an antimigration-modified covered self-expanding metal stent. Gastrointest Endosc 64(6):1024–1026PubMedCrossRef

16.

Leers JM, Vivaldi C, Schäfer H, Bludau M, Brabender J, Lurje G, Herbold T, Hölscher AH, Metzger R (2009) Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc 23(10):2258–2262PubMedCrossRef

17.

van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD (2011) Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 33(12):1292–1301PubMedCrossRef

18.

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

19.

Hünerbein M, Stroszczynski C, Moesta KT, Schlag PM (2004) Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 240(5):801–807PubMedCrossRef

20.

Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Devière J (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73(5):890–899PubMedCrossRef

21.

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(3):356–361PubMedCrossRef

22.

DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235(5):640–645PubMedCrossRef

23.

Eisendrath P, Cremer M, Himpens J, Cadière GB, Le Moine O, Devière J (2007) Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy 39(7):625–630PubMedCrossRef

24.

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(3):931–936PubMedCrossRef

25.

Dai YY, Gretschel S, Dudeck O, Rau B, Schlag PM, Hünerbein M (2009) Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents. Br J Surg 96(8):887–891PubMedCrossRef

26.

Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, Chisbert JJ (2007) Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg 17(7):866–872PubMedCrossRef

27.

Puli SR, Spofford IS, Thompson CC (2012) Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc 75(2):287–293PubMedCrossRef

28.

Oshiro T, Kasama K, Umezawa A, Kanehira E, Kurokawa Y (2010) Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obesity Surg 20(4):530–534CrossRef

29.

Vanbiervliet G, Filippi J, Karimdjee BS, Venissac N, Iannelli A, Rahili A, Benizri E, Pop D, Staccini P, Tran A, Schneider S, Mouroux J, Gugenheim J, Benchimol D, Hébuterne X (2012) The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc 26(1):53–59PubMedCrossRef

30.

van Heel NC, Haringsma J, Wijnhoven BP, Kuipers EJ (2011) Endoscopic removal of self-expandable metal stents from the esophagus (with video). Gastrointest Endosc 74(1):44–50PubMedCrossRef

31.

Schweigert M, Dubecz A, Stadlhuber RJ, Muschweck H, Stein HJ (2011) Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation. Interact Cardiovasc Thorac Surg 12(2):147–151PubMedCrossRef

32.

Freeman RK, Vyverberg A, Ascioti AJ (2011) Esophageal stent placement for the treatment of acute intrathoracic anastomotic leak after esophagectomy. Ann Thorac Surg 92(1):204–208PubMedCrossRef

33.

Salinas A, Baptista A, Santiago E, Antor M, Salinas H (2006) Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2(5):570–572PubMedCrossRef

34.

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

35.

Feith M, Gillen S, Schuster T, Theisen J, Friess H, Gertler R (2011) Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol 9(3):202–210PubMedCrossRef

36.

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):39–46PubMedCrossRef

Title: Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital
Authors: Bart J. M. Leenders
Arnold Stronkhorst
Frans J. Smulders
Grard A. Nieuwenhuijzen
Lennard P. L. Gilissen
Publication date: 01-08-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2802-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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