title: Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent.
abstract: 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.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50937, Köln, Germany.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Leers
authors.forename: Carlo
authors.initials: C
authors.lastname: Vivaldi
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schäfer
authors.forename: Marc
authors.initials: M
authors.lastname: Bludau
authors.forename: Jan
authors.initials: J
authors.lastname: Brabender
authors.forename: Georg
authors.initials: G
authors.lastname: Lurje
authors.forename: Till
authors.initials: T
authors.lastname: Herbold
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Ralf
authors.initials: R
authors.lastname: Metzger
mesh_terms: 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
chemical_list: D003287:Contrast Media; D008670:Metals