title: Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy.
abstract: BACKGROUND
  In patients with esophagectomy and gastric pull up for esophageal carcinoma anastomotic leaks are a well-known complication and a major cause of morbidity and mortality.
  
  
  OBJECTIVE
  We evaluated stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy.
  
  
  METHODS
  269 patients with esophageal cancer (adenocarcinoma n = 212, squamous cell carcinoma n = 57) had undergone esophagectomy and gastric pull up with an intrathoracic anastomosis between January 1998 and December 2005. A thoracic anastomotic leak was clinically and endoscopically proven in 12 patients (4.5%). Endoscopic insertion of a self-expanding covered metal stent at the site of the anastomotic leak was performed in 10 patients; two patients were treated with fibrin glue.
  
  
  RESULTS
  Stents were successfully placed in all patients without complications. In all but one patient (n = 9) radiological examination showed complete closure of the leakage. In one patient the stent was endoscopically corrected and complete closure could be achieved thereafter. The stent could be removed after six weeks in five patients. Stent migration occurred in four patients. In all but one patient (n = 7) definitive leak occlusion was achieved. Two patients died during their hospital stayfor reasons not related to the stent placement.
  
  
  CONCLUSIONS
  Stent implantation in patients with thoracic anastomotic leaks after esophagectomy is an easily available and effective treatment option with low morbidity, but stent migration does occur.
authors: Department of Surgery SALK, Paracelsus Medizinische Privatuniversität Salzburg, Müllner Hauptstr. 48, A - 5020, Salzburg, Austria. w.kauer@salk.at
authors: Werner K H
authors: WK
authors: Kauer
authors: Hubert J
authors: HJ
authors: Stein
authors: Hans-Joachim
authors: HJ
authors: Dittler
authors: J Rüdiger
authors: JR
authors: Siewert
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013908:Thoracotomy / Q000379:methods
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