Implantation of a colorectal stent as a therapeutic approach in the treatment of esophageal leakage.
BACKGROUND
While the mortality of esophageal surgery has decreased due to technological advancements, there is still a complication rate of about 30%. One of the main complications is the anastomotic leakage associated with a significant rate of morbidity and mortality. To close the leakage the efficacy of self-expanding stents (SES) has been shown in different studies. However, the high rate of stent migration limits the use of commercial available stents. In our case we were faced with the problem that the diameter of all available stents was too small to attach tightly to the mucosal wall of the esophagogastric anastomosis.


METHODS
We used, for the first time to our knowledge, a metal stent designed for colorectal application in an extensive anastomotic leak after esophageal resection in a patient with an esophageal cancer. After primary surgery with subtotal esohagectomy the anastomotic leak was stented endoscopically with a Polyflex self-expanding covered plastic stent after no response to intensive conventional management. Even though the stent was placed correctly, the diameter of the Polyflex stent was too small to attach onto the wall of the esophagogastric anastomosis. Again surgery was performed with a thoracal resection of the esophageal remnant and a hand made anastomosis. Unfortunately, again an anastomotic leak was detected soon after. To close the leak we decided to use a covered colorectal stent (Hanarostent) with an inner diameter of 30 mm. Sixteen weeks later the stent was extracted and complete mucosal healing of the esophageal leak was observed.


CONCLUSIONS
The stent implantation with a large wide diameter offers a good chance to close more extensive leaks and prevent stent migration.
Scharf
Jens-Gerd
JG
Department of Gastroenterology and Endocrinology, Georg-August-University, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. jscharf@med.uni-goettingen.de
Ramadori
Giuliano
G
Becker
Heinz
H
Müller
Annegret
A
D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000150:complications* / Q000628:therapy; D004940:Esophageal Stenosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents; D016896:Treatment Outcome