Año 2016 / Volumen 108 / Número 3
Original
Self-expanding metal stents in postoperative esophageal leaks

133-137

DOI: 10.17235/reed.2016.3987/2015

Eduardo Rodrigues-Pinto, Pedro Pereira, Armando Ribeiro, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo,

Resumen
Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation. Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks. Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal. Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days. Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Rutegård M, Lagergren P, Rouvelas I, et al. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol. 2012;19:99-103.
2. Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000;26:168-71
3. Nowakowski P, Ziaja K, Ludyga T, et al. Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula. Dis Esophagus. 2007;20:358-60
4. White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg. 1992;58:112-9
5. Reeder LB, DeFilippi VJ, Ferguson MK. Current results of therapy for esophageal perforation. Am J Surg. 1995;169:615-7
6. Sawyer R, Phillips C, Vakil N. Short- and long-term outcome of esophageal perforation. Gastrointest Endosc. 1995;41:130-4
7. Shaker H, Elsayed H, Whittle I, et al. The influence of the 'golden 24-h rule' on the prognosis of oesophageal perforation in the modern era. Eur J Cardiothorac Surg. 2010;38:216-22.
8. Noble F, Curtis N, Harris S, et al. South Coast Cancer Collaboration–Oesophago-Gastric (SC-OG). Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection. J Gastrointest Surg. 2012;16:1083-95.
9. Tsujimoto H, Ono S, Takahata R, et al. Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy. Surg Today. 2012;42:141-6.
10. Bhatia P, Fortin D, Inculet RI, et al. Current concepts in the management of esophageal perforations: a twenty-seven year Canadian experience. Ann Thorac Surg. 2011;92:209-15.
11. Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg. 2004;10:71-5
12. Karl RC, Schreiber R, Boulware D, et al. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg. 2000;231:635-43
13. Freeman RK, Ascioti AJ, Giannini T, et al. Analysis of unsuccessful esophageal stent placements for esophageal perforation, fistula, or anastomotic leak. Ann Thorac Surg. 2012;94:959-64; discussion 964-5
14. Page RD, Shackcloth MJ, Russell GN, et al. Surgical treatment of anastomotic leaks after oesophagectomy. Eur J Cardiothorac Surg. 2005;27:337-43
15. Junemann-Ramirez M, Awan MY, Khan ZM, et al. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005;27:3-7
16. Freeman RK, Van Woerkom JM, Ascioti AJ. Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg. 2007;83:2003-7; discussion 2007-8
17. Dai YY, Gretschel S, Dudeck O, et al. Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents. Br J Surg. 2009;96:887-91.
18. Schubert D, Scheidbach H, Kuhn R, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61:891-6
19. Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73:890-9.
20. El Hajj II, Imperiale TF, Rex DK, et al. Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc. 2014;79:589-98.
21. Orive-Calzada A, Calderón-García Á, Bernal-Martínez A, et al. Closure of benign leaks, perforations, and fistulas with temporary placement of fully covered metal stents: a retrospective analysis. Surg Laparosc Endosc Percutan Tech. 2014;24:528-36.
Artículos relacionados

Editorial

Cribado del cáncer colorrectal y supervivencia

DOI: 10.17235/reed.2018.5870/2018

Instrucciones para citar
Rodrigues-Pinto E, Pereira P, Ribeiro A, Moutinho-Ribeiro P, Lopes S, Macedo G, et all. Self-expanding metal stents in postoperative esophageal leaks. 3987/2015


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 1461 veces.
Este artículo ha sido descargado 95 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 27/08/2015

Aceptado: 24/12/2015

Prepublicado: 20/01/2016

Publicado: 26/02/2016

Tiempo de revisión del artículo: 115 días

Tiempo de prepublicación: 146 días

Tiempo de edición del artículo: 183 días


Compartir
Este artículo aun no tiene valoraciones.
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas