Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks |
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Authors: | P Salminen R Gullichsen S Laine |
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Institution: | (1) Department of Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland |
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Abstract: | Background Esophageal perforations and extensive anastomotic leaks after esophageal resection or gastrectomy are surgical emergencies
with high mortality rates. In recent years, the use of self-expanding metallic stents (SEMS) has emerged as a promising treatment
alternative for bridging and sealing the damage. This study aimed to evaluate the role of covered SEMS for the management
of esophageal perforations and anastomotic leaks.
Methods All esophageal stent placement procedures (174 procedures for 157 patients) at the authors’ unit between January 1999 and
April 2008 were assessed by a retrospective chart review. Of the 157 patients, 10 (6.4%) were treated with SEMS for sealing
of an iatrogenic esophageal perforation (n = 4), a spontaneous esophageal rupture in Boerhaave’s syndrome (n = 4), or an anastomotic leakage (n = 2).
Results The median time from perforation or anastomotic leak to stent insertion was 13 days (range, 2 h to 48 days). The esophageal
leak was totally sealed for 8 (80%) of 10 patients. The overall mortality rate was 50% (n = 5), and three (30%) of the five deaths were related to the perforation (n = 2) or leakage (n = 1). In both of the perforation cases, the diagnosis and treatment were substantially delayed. One patient with an anastomotic
leak after gastrectomy died of the complication despite successful operative and SEMS treatment. Two of the deaths were unrelated
to the perforation. In both cases, the cause of death was a disseminated malignant disease.
Conclusions Traumatic perforations and anastomotic leaks can be treated effectively with covered SEMS together with adequate drainage
of the thoracic cavity even in cases of severely ill patients with inveterate esophageal perforations and leaks. |
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Keywords: | Anastomotic leak Boerhaave’ s syndrome Esophageal perforation Iatrogenic perforation Self-expanding metallic stents SEMS |
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