title: Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem.
abstract: OBJECTIVE
  There is controversy about the best way to treat esophageal anastomotic leakage. We evaluated the effects of treatment with self-expanding metal stents in patients with esophageal anastomotic leakage after esophagectomy or gastrectomy for cancer.
  
  
  METHODS
  We investigated outcomes and procedure-related complications of 115 patients who received endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy at a university hospital from 2004 to 2009. We also performed a systematic literature review on stent therapy and compared outcomes with that of other treatment regimens for esophageal anastomotic leakage.
  
  
  RESULTS
  Among the 115 patients who received stents, the in-hospital mortality rate was 9% and complete anastomotic healing was achieved in 70% (95% confidence interval [CI], 64%-76%). Stent dislocation occurred in 53% of the patients (95% CI, 43%-62%), in all patients with esophagocolonostomy, in 61% with esophagojejunostomy, and in 49% with esophagogastrostomy. Three percent of patients (95% CI, 1%-5%) needed laparotomy to remove dislocated stents. Elective endoscopic stent removal was performed in 80% of the patients after a median of 54 days (range 17-427 d); 12% of these patients developed symptomatic anastomotic strictures after stent removal.
  
  
  CONCLUSIONS
  Anastomoses completely heal in 70% of patients that receive endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy. Stent therapy should be used in the management of patients with adequately perfused esophageal anastomotic leakage. However, stent dislocation remains a common problem after surgery.
authors.affiliation: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. feith@chir.med.tu-muenchen.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Feith
authors.forename: Sonja
authors.initials: S
authors.lastname: Gillen
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Jörg
authors.initials: J
authors.lastname: Theisen
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Ralf
authors.initials: R
authors.lastname: Gertler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D016629:Esophagectomy / Q000009:adverse effects; D005743:Gastrectomy / Q000009:adverse effects; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome