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DOI: 10.1055/s-2004-825656
Use of Self-Expandable Plastic Stents For the Treatment of Esophageal Perforations and Symptomatic Anastomotic Leaks
Publikationsverlauf
Submitted 1 August 2003
Accepted after Revision 16 March 2004
Publikationsdatum:
28. Juli 2004 (online)
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Background and Study Aims: Extensive anastomotic leaks after esophageal resection and esophageal perforations are a therapeutic challenge. The aim of the present study was to assess the potential of the self-expandable Polyflex plastic stent for the treatment of these conditions.
Patients and Methods: Between January 2002 and March 2003, nine patients were treated with a self-expandable Polyflex plastic stent for sealing of thoracic esophagoenteric anastomotic leaks following surgical resection (n = 5) or esophageal perforation (n = 4).
Results: In all patients the stents were inserted successfully without technical problems. In all but two patients complete sealing of the leak was achieved as demonstrated by radiography with water-soluble contrast media. The stent migration rate was 30 % and repositioning of the migrated stents was possible in all cases. Complete mucosal healing of the esophageal leaks and stent extraction was achieved in six patients. The stents were in situ for an average period of 135 ± 78 days. Two critically ill patients with anastomotic leaks died in spite of stent insertion due to sepsis and one patient with esophageal perforation died due to the underlying malignant disease.
Conclusions: Our preliminary experience with the self-expanding and removable Polyflex plastic stent for the sealing of anastomotic leaks and esophageal perforations suggests that this stent is a feasible treatment option, in particular, for more extensive esophageal defects, patients with co-morbid conditions, and critically ill patients.
References
- 1 Siersema P D, Hop W C, van Blankenstein M. et al . A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc. 2001; 54 145-153
- 2 Vakil N, Morris A I, Marcon N. et al . A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001; 96 1791-1796
- 3 Kozarek R A, Raltz S, Brugge W R. et al . Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. Gastrointest Endosc. 1996; 44 562-567
- 4 Raijman I, Siddique I, Ajani J. et al . Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc. 1998; 48 172-179
- 5 Siersema P D, Homs M Y, Haringsma J. et al . Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc. 2003; 58 356-361
- 6 Doniec J M, Schniewind B, Kahlke V. et al . Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy. 2003; 35 652-658
- 7 Lee J G, Hsu R, Leung J W. Are self-expanding metal mesh stents useful in the treatment of benign esophageal stenoses and fistulas? An experience of four cases. Am J Gastroenterol. 2000; 95 1920-1925
- 8 Song H Y, Park S I, Do Y S. et al . Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up. Radiology. 1997; 203 131-136
- 9 Morgan R A, Ellul J P, Denton E R. et al . Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses. Radiology. 1997; 204 527-532
- 10 Roy-Choudhury S H, Nicholson A A, Wedgwood K R. et al . Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol. 2001; 176 161-165
- 11 Wassermann K, Koch A, Muller-Ehmsen J. et al . Clinical and laboratory evaluation of a new thin-walled self-expanding tracheobronchial silicone stent: progress and pitfalls. J Thorac Cardiovasc Surg. 1997; 114 527-534
- 12 Bethge N, Vakil N. A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction. Am J Gastroenterol. 2001; 96 1350-1354
- 13 Decker P, Lippler J, Decker D. et al . Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature. Surg Endosc. 2001; 15 1444-1447
- 14 Dormann A J, Eisendrath P, Wigginghaus B. et al . Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy. 2003; 35 207-211
- 15 Dormann A J, Wigginghaus B, Deppe H. et al . Successful treatment of esophageal perforation with a removable self-expanding plastic stent. Am J Gastroenterol. 2001; 96 923-924
- 16 Urschel J D. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995; 169 634-640
- 17 Pross M, Manger T, Reinheckel T. et al . Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc. 2000; 51 73-76
- 18 Tasdemir O, Kucukaksu D S, Karagoz H. et al . Beneficial effects of fibrin glue on esophageal perforation. Ann Thorac Surg. 1996; 61 1589
- 19 Seibert D G. Use of an endoscopic clipping device to repair a duodenal perforation. Endoscopy. 2003; 35 189
- 20 Cipolletta L, Bianco M A, Rotondano G. et al . Endoscopic clipping of perforation following pneumatic dilation of esophagojejunal anastomotic strictures. Endoscopy. 2000; 32 720-722
- 21 Cwikiel W, Willen R, Stridbeck H. et al . Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases. Radiology. 1993; 187 667-671
- 22 Siersema P D, Hop W C, van Blankenstein M. et al . A new design metal stent (Flamingo stent) for palliation of malignant dysphagia: a prospective study. The Rotterdam Esophageal Tumor Study Group. Gastrointest Endosc. 2000; 51 139-145
- 23 Hramiec J E, O’Shea M A, Quinlan R M. Expandable metallic esophageal stents in benign disease: a cause for concern. Surg Laparosc Endosc. 1998; 8 40-43
- 24 Catnach S, Barrison I. Self-expanding metal stents for the treatment of benign esophageal strictures. Gastrointest Endosc. 2001; 54 140
C. M. Gelbmann, M. D.
Department of Internal Medicine I · University of Regensburg
93042 Regensburg · Germany
Fax: + 49-9419447016
eMail: cornelia.gelbmann@klinik.uni-regensburg.de