Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage.
BACKGROUND
Covered metallic or plastic stent placement has become an important treatment for postoperative esophageal leakage; however, fluoroscopic guidance is also required. Here we present a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration.


OBJECTIVE
To describe our experience with 7 patients who underwent PR-SEMS insertion with the direct-vision technique and our use of the transnasal endoscope without fluoroscopy.


METHODS
Prospective outcome study.


METHODS
A tertiary-care referral university hospital.


METHODS
This study involved all patients at our center who experienced postoperative esophageal leakage after esophagectomy, primary closure, or total gastrectomy.


METHODS
PR-SEMS insertion with the direct vision technique and use of transnasal endoscopy without fluoroscopy.


METHODS
Success rate of stent insertion, healing rate of postoperative esophageal leaks, and stent migration rate.


RESULTS
All stents were placed at the expected location without complications. One patient had massive hematemesis and underwent surgery. The bleeding focus was the splenic artery, which was damaged during gastrectomy. A significant marginal ulcer occurred in one patient, and the stent was immediately retrieved with an endoscope. After stent removal, 4 postoperative leakages were completely healed, and 2 lesions were not occluded. The 2 remaining minimal lesions became completely occluded with conservative management after stent removal. Stent migration did not occur.


CONCLUSIONS
A small number of patients. Further prospective, randomized, controlled trials are needed.


CONCLUSIONS
PR-SEMS insertion under transnasal endoscopic guidance is a feasible, safe, and effective treatment for postoperative esophageal leakage, and it can be performed as a bedside procedure. Our anchoring method is effective for the prevention of migration from nonobstructed lesions.
Lee
Kee Myung
KM
Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
Shin
Sung Jae
SJ
Hwang
Jae Chul
JC
Yoo
Byung Moo
BM
Cheong
Jae Youn
JY
Lim
Sun-Gyo
SG
Kim
Jae Keun
JK
Cho
Yong Kwan
YK
Han
Sang Uk
SU
Lee
Sang Rim
SR
Kim
Jin Hong
JH
D000368:Aged; D020878:Device Removal; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D020701:Esophagoscopes; D004946:Esophagostomy; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005743:Gastrectomy; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D013157:Splenic Artery / Q000293:injuries; D015607:Stents; D013274:Stomach Neoplasms / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000628:therapy*; D014456:Ulcer / Q000209:etiology