Treatment of benign perforations and leaks of the esophagus: factors associated with success after stent placement
Self-expanding metal stent (SEMS) is effective and safe for the treatment of benign esophageal perforations or leaks. The purpose of this study was to identify factors associated with clinical success after SEMS placement.
Patients who received SEMS placement for treatment of benign esophageal perforations or leaks were retrospectively identified. These patients were analyzed for factors associated with clinical success and complications.
A total of 31 patients underwent stent insertion for benign esophageal perforations (n = 11) or anastomotic leaks (n = 20). Clinical success was achieved in twenty-three patients (74.2%) after initial stent insertion. In multivariate analysis, early stent insertion within 1 day was identified as a significant independent predictor of successful sealing (Odds ratio = 3.14, 95% CI 1.36–7.24; p = 0.013). The anastomotic leak group needed a longer stent dwelling time (≥ 4 weeks) compared to the perforation group (75.0% vs. 27.3%, p = 0.022).
Clinical success was significantly associated with early stent insertion. The dwelling time of stent was shorter for benign perforations compared to anastomotic leaks.
KeywordsSelf-expanding metal stent Benign esophageal perforation Anastomotic leakage
The English in this document has been checked by at least two professional editors, both native speakers of English.
Compliance with ethical standards
Drs. Cheal Wung Huh, Joon Sung Kim, Hyun Ho Choi, Ja In Lee, Jeong-Seon Ji, Byung-Wook Kim, and Hwang Choi have no conflicts of interest or financial ties to disclose.
- 1.Altorjay A, Kiss J, Voros A, Bohak A (1997) Nonoperative management of esophageal perforations. Is it justified?. Ann Surg 225:415–421, http://www.ncbi.nlm.nih.gov/pubmed/9114801
- 8.Shim CN, Kim HI, Hyung WJ, Noh SH, Song MK, Kang DR, Park JC, Lee H, Shin SK, Lee YC, Lee SK (2014) Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy? Surg Endosc 28:833–840. https://doi.org/10.1007/s00464-013-3228-5 CrossRefPubMedGoogle Scholar
- 10.van Boeckel PG, Dua KS, Weusten BL, Schmits RJ, Surapaneni N, Timmer R, Vleggaar FP, Siersema PD (2012) Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 12:19. https://doi.org/10.1186/1471-230X-12-19 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.van Halsema EE, Kappelle WFW, Weusten B, Lindeboom R, van Berge Henegouwen MI, Fockens P, Vleggaar FP, Spaander MCW, van Hooft JE (2017) Stent placement for benign esophageal leaks, perforations, and fistulae: a clinical prediction rule for successful leakage control. Endoscopy. https://doi.org/10.1055/s-0043-118591 PubMedGoogle Scholar
- 17.Wedemeyer J, Brangewitz M, Kubicka S, Jackobs S, Winkler M, Neipp M, Klempnauer J, Manns MP, Schneider AS (2010) Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system. Gastrointest Endosc 71:382–386. https://doi.org/10.1016/j.gie.2009.07.011 CrossRefPubMedGoogle Scholar
- 18.Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61:891–896, http://www.ncbi.nlm.nih.gov/pubmed/15933696
- 19.Takimoto Y, Nakamura T, Yamamoto Y, Kiyotani T, Teramachi M, Shimizu Y (1998) The experimental replacement of a cervical esophageal segment with an artificial prosthesis with the use of collagen matrix and a silicone stent. J Thorac Cardiovasc Surg 116:98–106. https://doi.org/10.1016/S0022-5223(98)70247-8 CrossRefPubMedGoogle Scholar
- 20.Cwikiel W, Willen R, Stridbeck H, Lillo-Gil R, von Holstein CS (1993) Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases. Radiology 187:667–671. https://doi.org/10.1148/radiology.187.3.8497612 CrossRefPubMedGoogle Scholar
- 23.Boulis NM, Armstrong WS, Chandler WF, Orringer MB (1999) Epidural abscess: a delayed complication of esophageal stenting for benign stricture. Ann Thorac Surg 68:568–570, http://www.ncbi.nlm.nih.gov/pubmed/10475435