title: Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Kee Myung
authors.initials: KM
authors.lastname: Lee
authors.forename: Sung Jae
authors.initials: SJ
authors.lastname: Shin
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Hwang
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.forename: Jae Youn
authors.initials: JY
authors.lastname: Cheong
authors.forename: Sun-Gyo
authors.initials: SG
authors.lastname: Lim
authors.forename: Jae Keun
authors.initials: JK
authors.lastname: Kim
authors.forename: Yong Kwan
authors.initials: YK
authors.lastname: Cho
authors.forename: Sang Uk
authors.initials: SU
authors.lastname: Han
authors.forename: Sang Rim
authors.initials: SR
authors.lastname: Lee
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
mesh_terms: 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