title: Self-expanding plastic stents for the treatment of post-operative esophago-jejuno anastomosis leak. A case series study.
abstract: OBJECTIVE
  Self-expandable plastic stents (SEPS) are increasingly being used for treatment of postoperative esophageal leak. This complication occurs in 4-27% of patients after radical gastrectomy, and has a high mortality rate up to 60%.The aim of this study is to evaluate the efficacy of SEPS (Polyflex®) for treatment of post-operative esophago-jejuno anastomosis leak after radical gastrectomy for gastric cancer.
  
  
  METHODS
  During one year period patients who underwent a radical gastrectomy in our hospital for gastric cancer and developed a postoperative anastomotic leak were prospectively included in the study after signing a consent form, and treated with SEPS placement under endoscopic and fluoroscopic control for leak occlusion.
  
  
  RESULTS
  Four patients were included (3 men/1 woman). The mean interval between operation and SEPS placement was 16 days (range: 4-34). SEPS deployment was easily performed in all patients with complete occlusion of esophageal lumen in three patients. In the fourth patient we needed to deploy a second coaxial stent to achieve a complete occlusion of the fistula. SEPS migration did not happen in our series. One patient had already developed a mediastinitis by the time we placed the SEPS and he died 3 days later. Extraction of the SEPS was easily performed 4-8 weeks after deployment.
  
  
  CONCLUSIONS
  We achieved a complete healing of the anastomotic fistula after radical gastrectomy in 3 out of 4 patients, without major complications related to SEPS. Placement of SEPS is an appealing minimally invasive alternative to surgical repair for patients with postoperative anastomotic leak.
authors.affiliation: Gastroenterology Department, POVISA Hospital, C/Salamanca 5, Vigo, Pontevedra, Spain. afvillaverde@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: J J
authors.initials: JJ
authors.lastname: Vila
authors.forename: S
authors.initials: S
authors.lastname: Vázquez
authors.forename: C
authors.initials: C
authors.lastname: González-Portela
authors.forename: M
authors.initials: M
authors.lastname: de la Iglesia
authors.forename: M
authors.initials: M
authors.lastname: Lozano
authors.forename: E
authors.initials: E
authors.lastname: Toscano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000628:therapy*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000628:therapy; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D015607:Stents; D013274:Stomach Neoplasms / Q000601:surgery