Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent.
BACKGROUND
Leaks of the esophagus are associated with a high mortality rate and need to be treated as soon as possible. Therapeutic options are surgical repair or resection or conservative management with cessation of oral intake and antibiotic therapy. We evaluated an alternative approach that uses self-expandable metallic stents (SEMS).


METHODS
Between 2002 and 2007, 31 consecutive patients with iatrogenic esophageal perforation (n = 9), intrathoracic anastomotic leak after esophagectomy (n = 16), spontaneous tumor perforation (n = 5), and esophageal ischemia (n = 1) were treated at our institution. All were treated with endoscopic placement of a covered SEMS. Stent removal was performed 4 to 6 weeks after implantation. To exclude continuous esophageal leak after SEMS placement, radiologic examination was performed after stent implantation and removal.


RESULTS
SEMS placement was successful in all patients and a postinterventional esophagogram demonstrated full coverage of the leak in 29 patients (92%). In two patients, complete sealing could not be achieved and they were referred to surgical repair. Stent migration was seen in only one patient (3%). After removal, a second stent with larger diameter was placed and no further complication occurred. Two patients died: one due to myocardial infarction and one due to progressive ischemia of the esophagus and small bowl as a consequence of vascular occlusion. Stent removal was performed within 6 weeks, and all patients had radiologic and endoscopic evidence of esophageal healing.


CONCLUSIONS
Implantation of covered SEMS in patients with esophageal leak or perforation is a safe and feasible alternative to operative treatment and can lower the interventional morbidity rate.
Leers
Jessica M
JM
Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50937, Köln, Germany.
Vivaldi
Carlo
C
Schäfer
Hartmut
H
Bludau
Marc
M
Brabender
Jan
J
Lurje
Georg
G
Herbold
Till
T
Hölscher
Arnulf H
AH
Metzger
Ralf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003287:Contrast Media; D020878:Device Removal; D004935:Esophageal Diseases / Q000601:surgery; D004939:Esophageal Perforation / Q000000981:diagnostic imaging / Q000628:therapy*; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008670:Metals; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D015607:Stents
D003287:Contrast Media; D008670:Metals