Advertisement

CardioVascular and Interventional Radiology

, Volume 34, Issue 6, pp 1267–1271 | Cite as

Covered Biodegradable Stent: New Therapeutic Option for the Management of Esophageal Perforation or Anastomotic Leak

  • Marie Černá
  • Martin Köcher
  • Vlastimil Válek
  • René Aujeský
  • Čestmír Neoral
  • Tomáš Andrašina
  • Jiří Pánek
  • Shankari Mahathmakanthi
Clinical Investigation

Abstract

Purpose

This study was designed to evaluate our experience with the treatment of postoperative anastomotic leaks and benign esophageal perforations with covered biodegradable stents.

Materials and Methods

From 2008 to 2010, we treated five men with either an anastomotic leak or benign esophageal perforation by implanting of covered biodegradable Ella-BD stents. The average age of the patients was 60 (range, 38–74) years. Postoperative anastomotic leaks were treated in four patients (1 after esophagectomy, 1 after resection of diverticulum, 2 after gastrectomy). In one patient, perforation occurred as a complication of the treatment of an esophageal rupture (which occurred during a balloon dilatation of benign stenosis) with a metallic stent.

Results

Seven covered biodegradable stents were implanted in five patients. Primary technical success was 100%. Clinical success (leak sealing) was achieved in four of the five patients (80%). Stent migration occurred in three patients. In two of these patients, the leak had been sealed by the time of stent migration, therefore no reintervention was necessary. In one patient an additional stent had to be implanted.

Conclusion

The use of biodegradable covered stents for the treatment of anastomotic leaks or esophageal perforations is technically feasible and safe. The initial results are promising; however, larger number of patients will be required to evaluate the capability of these biodegradable stents in the future. The use of biodegradable material for coverage of the stent is essential.

Keywords

Esophageal fistula Esophageal perforation Stent Biodegradable stent 

Notes

Acknowledgments

This work was supported by IGA MZ ČR NS 10288-3/2009

Conflict of interest

I certify that there is no actual or potential conflict of interest in relation to this article.

References

  1. 1.
    Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:634–640PubMedCrossRefGoogle Scholar
  2. 2.
    Brinster CJ, Singhal S, Lee L et al (2004) Evolving option in the management of esophageal perforation. Ann Thor Surg 77:1475–1483CrossRefGoogle Scholar
  3. 3.
    Onat S, Ulku R, Cugdem KM et al (2010) Factor affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single centre. J Cardiothorac Surg 5:46PubMedCrossRefGoogle Scholar
  4. 4.
    Schmidt SC, Strauch S, Rösch T et al (2010) Management of esophageal perforations. Surg Endosc 24(11):2809–2813PubMedCrossRefGoogle Scholar
  5. 5.
    Katsanos K, Sabharwal T, Adam A (2010) Stenting of the upper gastrointestinal tract: current status. Cardiovasc Intgervent Radiol 33:690–705CrossRefGoogle Scholar
  6. 6.
    Fischer A, Thomusch O, Benz S et al (2006) Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg 81:467–472PubMedCrossRefGoogle Scholar
  7. 7.
    Eloubeidi MA, Lopes TL (2009) Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans. Am J Gastroenterol 104:1374–1381PubMedCrossRefGoogle Scholar
  8. 8.
    Leers JM, Vivaldi C, Schafer H et al (2009) Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc 23:2258–2262PubMedCrossRefGoogle Scholar
  9. 9.
    Salminen P, Gullichsen R, Laine S (2009) Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc 23:1526–1530PubMedCrossRefGoogle Scholar
  10. 10.
    Tuebergen D, Rijcken E, Mennigen R et al (2008) Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg 12:1168–1176PubMedCrossRefGoogle Scholar
  11. 11.
    Dua KS, Vleggaar FP, Santharam R et al (2008) Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal strictures: a prospective two-center study. Am J Gastroenterol 103:2988–2994PubMedCrossRefGoogle Scholar
  12. 12.
    Saito Y, Tanaka T, Andoh A et al (2007) Usefulness of biodegradable stents constructed of poly-/-lactic acid monofilaments in patients with benign esophageal stenosis. World J Gastroenterol 13:3977–3980PubMedGoogle Scholar
  13. 13.
    Goldin E, Fiorini A, Ratan Y et al (1996) A new biodegradable and self-expandable stent for benign esophageal strictures. Gastrointest Endosc 43:294CrossRefGoogle Scholar
  14. 14.
    Fry SW, Fleischer DE (1997) Management of a refractory benign esophageal stricture with a new biodegradable stent. Gastrointest Endosc 45:179–182PubMedCrossRefGoogle Scholar
  15. 15.
    Tanaka T, Takahashi M, Nitta N et al (2006) Newly developed biodegradable stents for benign gastrointestinal tract stenoses: a preliminary clinical trial. Digestion 74:199–205PubMedCrossRefGoogle Scholar
  16. 16.
    Stivaros SM, Williams LR, Senger C et al (2010) Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. Eur Radiol 20:1069–1072PubMedCrossRefGoogle Scholar
  17. 17.
    Hair CS, Devonshire DA (2010) Severe hyperplastic tissue stenosis of a novel biodegradable esophageal stent and subsequent successful management with high pressure balloon dilatation. Endoscopy 42(Suppl 2):E132–E133PubMedCrossRefGoogle Scholar
  18. 18.
    Orive-Calzada A, Alvarez-Rubio M, Romeo-Izquierdos S et al (2006) Severe epithelial hyperplasia as a complication of a novel biodegradable stent. Endoscopy 41(Suppl 2):E137–E138Google Scholar
  19. 19.
    Zilberman M, Nelson KD, Eberhart RC (2005) Mechanical properties and in vitro degradation of bioresorbable fibers and expandable fiber-based stents. J Biomed Mater Res B 74:792–799Google Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • Marie Černá
    • 1
  • Martin Köcher
    • 1
  • Vlastimil Válek
    • 2
  • René Aujeský
    • 3
  • Čestmír Neoral
    • 3
  • Tomáš Andrašina
    • 2
  • Jiří Pánek
    • 2
  • Shankari Mahathmakanthi
    • 1
  1. 1.Department of RadiologyUniversity HospitalOlomoucCzech Republic
  2. 2.Department of RadiologyUniversity HospitalBrnoCzech Republic
  3. 3.Department of SurgeryUniversity HospitalOlomoucCzech Republic

Personalised recommendations