Successful Sealing of Benign Esophageal Leaks after Temporary Placement of a Self-Expanding Plastic Stent without Fluoroscopic Guidance

Zusammenfassung

Einleitung: Wir beschreiben unsere Erfahrung mit dem passageren Einsatz eines selbstexpandierenden Plastikstents (SEPS) bei Patienten mit nichtmaligner Ösophagusleckage. Material und Methoden: Zwischen November 2001 und Mai 2005 wurden 10 Patienten mit einer iatrogenen Perforation (n = 4), einer Leckage nach einem ösophagochirurgischen Eingriff (n = 5) und mehreren ösophagomediastinalen Fisteln nach Laugenverätzung (n = 1) durch den passageren Einsatz eines SEPS behandelt. Bei 8/10 Patienten erfolgte die Stentplatzierung aufgrund der Notfallsituation ohne Durchleuchtungskontrolle. Die Stententfernung erfolgte mittels einer Stentfasszange. Ergebnisse: Die Leckagenlokalisation befand sich im proximalen (n = 1), mittleren (n = 6) und distalen (n = 3) Ösophagus. Die mittlere Leckagengröße betrug 2 cm. Eine Stentplatzierung ohne Durchleuchtungskontrolle war in allen Fällen erfolgreich. Die mittlere Dauer der Stenttherapie betrug 55,5 Tage (Spanne 15 - 438 Tage). Ein Verschluss der Leckage zeigte sich nach komplikationsloser Stententfernung bei 7/10 Patienten. Insgesamt verstarben 4 Patienten während der Nachbeobachtungszeit. Keiner dieser Todesfälle war stentassoziiert. Diskussion: Der passagere Einsatz eines SEPS ist eine sichere und erfolgreiche Methode zur Abdichtung nichtmaligner Ösophagusleckagen. Eine Platzierung des Stents ohne Durchleuchtungskontrolle ist möglich. Bei Perforationen von begrenztem Ausmaß und ohne ausgeprägte Mediastinitis stellt der Einsatz eines SEPS eine schonende Primärtherapie dar.

Abstract

Introduction: We report on our experience with the temporary use of a self-expanding plastic stent (SEPS) in the treatment of non-malignant esophageal leaks. Material and Methods: Between November 2001 and May 2005 ten patients with iatrogenic esophageal perforations (n = 4), post-surgical leaks (n = 5) and esophago-mediastinal fistulas after caustic injury (n = 1) were treated by temporary SEPS placement. In eight out of ten patients SEPS placement was done without fluoroscopy due to the emergency setting. Stent removal was performed with a rat-toothed forceps. Results: Leaks were located in the proximal (n = 1), middle (n = 6) and distal (n = 3) parts of the esophagus. The mean leakage size was 2 cm. Stent placement without fluoroscopy was always successful. The median duration of stent therapy was 55.5 days (range 15 438). In 7/10 cases the SEPS was readily removed, showing complete healing of the former leak. Four patients died during the follow-up. However, their deaths were not related to the stent therapy. Discussion: The temporary use of the SEPS represents a safe method for sealing benign esophageal leaks. In the emergency-setting SEPS placement without fluoroscopy is feasible and the stent can be easily removed. In contained perforations without severe mediastinitis of the mid esophagus the SEPS should be discussed as a gentle first-line therapy.

Ösophagusstent - Ösophagusleckage - Ösophagusfistel - Anastomoseninsuffizienz

esophageal stent - esophageal leak - esophageal perforation - esophageal anastomotic insufficiency

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