Pilot data on the endoscopic placement of covered metal stents to treat gastrojejunal leaks in a porcine model.
BACKGROUND
Placement of stents may be an alternative option to treat gastrojejunal (GJ) anastomotic leaks after Roux-en-Y gastric bypass (RYGB) surgery. The aim was to evaluate the performance of a covered metal stent (Alimaxx-E, 18 x 100 mm) across a GJ leak in a porcine model.


METHODS
In eight pigs, a RYGB was performed and a 1-cm leak was created. A retrogastric and anterogastric GJ was performed equally with four pigs in each group. Stents were placed across the GJ anastomosis using endoscopy and fluoroscopy. The endpoints were position of the stents, healing of the leak, and complications at necropsy.


RESULTS
Stent placement was feasible in all pigs it was attempted. In the retrogastric GJ group, pigs without stents survived 2 weeks without complications. Two pigs with stents died on postoperative days (PODs) 4 and 5. In the anterogastric GJ group, one pig with one stent survived 2 weeks with healing of the leak but with stent migration into the Roux limb. The remaining three pigs died between PODs 4 and 6. Pressure necrosis of the Roux limb caused by the distal end of the stent was found in all.


CONCLUSIONS
Placement of fully covered metal stents is feasible. The use of small pigs with a thin small bowel wall in combination with relatively large stents was most likely the reason for complications found in all stented animals. Further studies of GJ leaks using these stents will require larger pigs or a different species.
Sporn
Emanuel
E
Department of Surgery, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA.
Miedema
Brent W
BW
Astudillo
J Andres
JA
Whang
Susan H
SH
Karch
Joe
J
Thaler
Klaus
K
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D010865:Pilot Projects; D011183:Postoperative Complications / Q000601:surgery*; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D015607:Stents; D013270:Stomach / Q000601:surgery; D013552:Swine; D016896:Treatment Outcome