title: From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of "stent-guided regeneration and re-epithelialization".
abstract: BACKGROUND
  Iatrogenic intestinal tract perforation and anastomotic disunion traditionally required surgical treatment. Complete anastomotic break was considered until now as an absolute contraindication for endoscopic management.
  
  
  OBJECTIVE
  The aim of this series was to show that endoscopic management is able to treat a spectrum of bowel wall breaks, from focal perforation to complete anastomotic disunion.
  
  
  METHODS
  A single-center prospective cohort study.
  
  
  METHODS
  Nine consecutive patients with nonmalignant gastrointestinal perforations were treated with endoscopic stenting between 2005 and 2008. Perforations were related to endoscopic perforations (4 cases: 2 esophageal and 2 colorectal), postoperative fistula or leakage (2 cases: 1 colorectal anastomosis and 1 esophageal), and complete anastomotic disunion (3 cases: 2 ileoanal anastomosis and 1 esophagogastric anastomosis).
  
  
  METHODS
  All 9 patients underwent endoscopic installation of fully covered stents under endoscopic and radiologic guidance, sometimes associated with simultaneous endoscopic collection drainage. Oral feeding was resumed when radiologic contrast studies showed no residual leak.
  
  
  RESULTS
  The outcome in all 9 patients was favorable. Two migrated stents were replaced, and 2 stents were spontaneously expelled without consequence. All stents were withdrawn within an average of 5 weeks.
  
  
  CONCLUSIONS
  Uncontrolled pilot study, small sample size.
  
  
  CONCLUSIONS
  The successful endoscopic management of bowel wall breaks ranging from perforation to complete postoperative disunion with fully covered stent could support a new concept of "stent-guided regeneration and re-epithelialization." Controlled trials are needed before this new endoscopic treatment can be proposed as a substitute for traditional treatments.
authors.affiliation: Department of Gastroenterology, Hôpital Nord, Marseille, France.
authors.forename: Laila
authors.initials: L
authors.lastname: Amrani
authors.forename: Charles
authors.initials: C
authors.lastname: Ménard
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
authors.forename: Olivier
authors.initials: O
authors.lastname: Emungania
authors.forename: Phillipe Ah
authors.initials: PA
authors.lastname: Soune
authors.forename: Clément
authors.initials: C
authors.lastname: Subtil
authors.forename: Christian
authors.initials: C
authors.lastname: Brunet
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016145:Endoscopy, Digestive System; D004939:Esophageal Perforation / Q000628:therapy; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa; D007416:Intestinal Perforation / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012038:Regeneration; D015607:Stents