Año 2021 / Volumen 113 / Número 1
Original
Endoscopic treatment of postoperative esophagogastric leaks with fully covered self-expanding metal stents

14-22

DOI: 10.17235/reed.2020.6821/2019

Elena Iglesias Jorquera, Juan Egea Valenzuela, Andrés Serrano Jiménez, Gabriel Carrilero Zaragoza, Antonio Ortega Sabater, Eduardo Sánchez Velasco, David Ruiz de Angulo, Vicente Munitiz, Pascual Parrilla, Fernando Alberca de las Parras,

Resumen
Background: the management of postoperative esophageal leaks is a huge therapeutic challenge. Thanks to the advances in endoscopy, treatment with esophageal stents has been proposed as a valid option. Aims: the main objective of the study was to evaluate the effectiveness and safety of the use of fully covered esophageal metal stents in the treatment of postoperative esophageal leaks. Methods: a retrospective observational study was performed in patients with postoperative esophageal leaks, treated with fully covered self-expandable metal stents between June 2011 and May 2018. Results: twenty-five patients were evaluated and 34 stents were placed. The closure of the leak was observed in 21 patients after removal of the stent, with an overall technical success rate of 84 %. The mean time with a stent placed for closure of the fistula was 55.7 ± 27.11 days/patient (mean of 39 ± 24.30 days/stent). The most frequent complication was a partial distal stent migration (7/34 stents), followed by five cases of complete migration into the stomach. Conclusions: endoscopic treatment with fully covered self-expandable metal stents seems to be an effective and safe first-line treatment for postoperative esophageal leaks, according to the experience in our center.
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Bibliografía
1. Crestanello JA, Deschamps C, Cassivi SD, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 2005;129:254–60.
2. Kassis ES, Kosinski AS, Ross P Jr., et al. Predictors of anastomotic leak after esophagectomy: an analysis of the Society of Thoracic Surgeons general thoracic database. Ann Thorac Surg 2013;96:1919–26.
3. Ruiz de Angulo D, Ortiz MÁ, Munitiz V, et al. Role of self-expanding stents in the treatment of intrathoracic dehiscence after Ivor Lewis esophagectomy. Cir Esp 2018;96(9):555-9.
4. Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leak in a serie of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000;26:168-71.
5. Pacelli F, Papa V, Rosa F, et al. Four hundred consecutive total gastrectomies for gastric cancer - A single-institution experience. Archives of Surgery 2008;143(8):769–75.
6. Selby LV, Vertosick EA, Sjoberg DD, et al. Morbidity after total gastrectomy: analysis of 238 patients. J Am Coll Surg 2005;220(5):863-71.
7. Walsh C, Karmali S. Endoscopic management of bariatric complications: a review and update. World J Gastrointest Endosc 2015;7(5):518-23.
8. Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A metaanalysis. Am J Surg 2014;208(6):903-10.
9. Spaander MC, Baron TH, Siersema PD, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016;48:939–48.
10. Oprisanescu D, Bucur D, Sandru V, et al. Endoscopic Treatment of Benign Esophageal Fistulas Using Fully-covered Metallic Esophageal Stents. Chirurgia 2018;113:108-15.
11. Klimczak T, Klimczak J, Szewczyk T, et al. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc 2018;32:2038–45.
12. González JM, Servajean C, Aider B, et al. Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series. Surg Endosc 2016;30:4895–903.
13. Licht E, Markowitz AJ, Bains MS, et al. Endoscopic management of esophageal anastomotic leaks after surgery for malignant disease. Ann Thorac Surg 2016;101:301-4.
14. Aryaie AH, Singer JL, Fayezizadeh M, et al. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc 2017;31:612–7.
15. Rodrigues-Pinto E, Pereira P, Ribeiro A, et al. Self-expanding metal stents in postoperative esophageal leaks. Rev Esp Enferm Dig 2016;108(3):133-7.
16. Fernández A, González-Carrera V, González-Portela C, et al. Fully covered metal stents for the treatment of leaks after gastric and esophageal surgery. Rev Esp Enferm Dig 2015;107(10):608-13.
17. Al-issa MA, Petersen TI, Taha AY, et al. The Role of Esophageal Stent Placement in the Management of Postesophagectomy Anastomotic Leak. Saudi J Gastroentero 2014;20(1):39-42.
18. Anderloni A, Genco C, Massidda M, et al. Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience. Dig Surg 2018;5:1-8.
19. Alldinger I, Schmitt M, Dreesbach J, et al. Endoscopic treatment of anastomotic leakage after esophagectomy or gastrectomy for carcinoma with self-expanding removable stents. Hepato-Gastroenterol 2014;61:111-4.
20. Galloro G, Magno L, Musella M, et al. A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series. Surg Obes Relat Dis 2014;10:607–12.
21. Fishman S, Shnell M, Gluck N, et al. Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy. Gastrointest Endosc 2014;81:1291–4.
22. Van Wezenbeek MR, de Milliano MM, Nienhuijs SW, et al. A Specifically Designed Stent for Anastomotic Leaks after Bariatric Surgery: Experiences in a Tertiary Referral Hospital. Obes Surg 2016;26:1875–80.
23. Shehab HM, Hakky SM, Gawdat KA. An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video) Obes Surg 2016;26:941–8.
24. Alventosa Mateu C, Sempere García-Argüelles J, Suárez Callol P, et al. Experience with a new self-expanding metal stent specifically designed for wound dehiscence after sleeve gastrectomy. Gastroenterol Hepatol 2016;39(7):460-3.
25. Garofalo F, Noreau-Nguyen M, Denis R, et al. Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis 2017;13(6):925-32.
26. Huh CW, Kim JS, Choi HH, et al. Treatment of benign perforations and leaks of the esophagus: factors associated with success after stent placement. Surg Endosc 2018;32(8):3646-51.
27. Van Boeckel PGA, Sijbring A, Vleggaar FP. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 2011;33:1292–301.
28. Dasari BVM, Neely D, Kennedy A, et al. The Role of Esophageal Stents in the Management of Esophageal Anastomotic Leaks and Benign Esophageal Perforations. Ann Surg 2014;259(5):852-60.
29. Wang C, Lou C. Randomized controlled trial to investigate the effect of metal clips on early migration during stent implantation for malignant esophageal stricture. Can J Surg 2015;58(6):378-82.
30. Vanbiervliet G, Filippi J, Karimdjee BS, et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc 2012;26(1):53–9.
31. Irani S, Baron TH, Gluck M, et al. Preventing migration of fully covered esophageal stents with an over-the-scope clip device (with videos). Gastrointest endosc 2014;79(5):844-51.
32. Watanabe K, Hikichi T, Nakamura J, et al. Feasibility of esophageal stent fixation with an over-the-scope-clip for malignant esophageal strictures to prevent migration. Endosc Int Open 2017;05(11):E1044–9.
33. Shim CS, Cho YD, Moon JH, et al. Fixation of a modified covered esophageal stent: its clinical usefulness for preventing stent migration. Endoscopy 2001;33(10):843-8.
34. Law R, Prabhu A, Fujii-Lau L, et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc 2018;32(2):675-81.
35. Wright A, Chang A, Bedi AO, et al. Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS). Surg Endosc 2017;31(9):3489-94.
36. Ngamruengphong S, Sharaiha RZ, Sethi A, et al. Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study. Endoscopy 2016;48(9):802-8.
Instrucciones para citar
Iglesias Jorquera E, Egea Valenzuela J, Serrano Jiménez A, Carrilero Zaragoza G, Ortega Sabater A, Sánchez Velasco E, et all. Endoscopic treatment of postoperative esophagogastric leaks with fully covered self-expanding metal stents. 6821/2019


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Ficha Técnica

Recibido: 15/12/2019

Aceptado: 21/04/2020

Prepublicado: 29/10/2020

Publicado: 11/01/2021

Tiempo de revisión del artículo: 116 días

Tiempo de prepublicación: 319 días

Tiempo de edición del artículo: 393 días


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