USE OF SELF-EXPANDING METALLIC STENTS IN THE MANAGEMENT OF ESOPHAGEAL LEAKS AFTER SURGERY

Aims:

Esophageal leaks are severe complications after surgery. The use of endoscopic self-expanding metallic stents is a valid option. Our aim was to evaluate the usefulness of the stents in a third level referral center.

Methods:

Retrospective study including patients with esophageal leaks after surgery who received self-expanding metallic stents (June 2011 to December 2017).

Results:

We included 36 stents in 24 patients. There were 13 men (54%). The mean age was 56,8 ± 17,6 years (25 – 86). The indications for surgery were: neoplasms (15; 62,5%), bariatric (7; 29,2%), antireflux (1; 4,2%) and paraesophageal hernia (1; 4,2%). The mean time between the diagnosis of the leak and stent placement was 1,52 ± 3,06 days (1 – 12). In 17 patients (71%) the stent was placed within the first 24 hours.

Resolution of the leak was observed in 19 cases after stent removal. The rest needed re-stenting.

The rate of successful endoscopic treatment was 83%. The mean number of stents needed was 1,47/patient. The mean time needed was 57 day/patient, and 41,7 days/stent.

We observed one complete distal migration (the stent was replaced endoscopically) as early complication (≤48h). The rate of late complications (> 48h) was 41,7% (15/36): 7 partial distal migrations (4 were replaced and 3 were removed because the leak was closed); 3 migrations into the stomach (2 were replaced and the leak was closed in the other one); 2 bleeding events due to ulcers secondary to the stent (the stents were removed and no additional therapy was needed); 2 cases of intrastent overgrowth (one was removed, the other remained); 1 migration into mediastinum (endoscopically replaced).

Conclusions:

Self-expanding metallic stents are useful in the management of esophageal leaks after surgery. In most of the cases the leak is solved and new surgeries are avoided. The main complication is distal migration, but endoscopic replacement or removal is feasible.