title: Self-expandable metal stents for the treatment of benign upper GI leaks and perforations.
abstract: BACKGROUND
  Self-expandable metal stents (SEMSs) have been suggested for the treatment of benign upper GI leaks and perforations. Nevertheless, uncomplicated removal remains difficult. Placement of a self-expandable plastic stent (SEPS) into an SEMS can facilitate retrieval.
  
  
  OBJECTIVE
  This study reviews our experience with sequential SEMS/SEPS placement in patients with benign upper GI leaks or perforations.
  
  
  METHODS
  A retrospective review of the chart of each patient who underwent SEMS placement for benign upper GI leaks or perforations, including (1) fistula after bariatric surgery, (2) other postoperative fistulae, (3) Boerhaave syndrome, (4) iatrogenic perforations, and (5) other perforations.
  
  
  METHODS
  Single, tertiary center.
  
  
  METHODS
  Eighty-eight patients (37 male, average age 51.6 years, range 18-89 years).
  
  
  METHODS
  SEMS placement and removal, with or without SEPS placement.
  
  
  METHODS
  Feasibility of SEMS removal and successful treatment of lesions and short-term and long-term complications.
  
  
  RESULTS
  A total of 153 SEMSs were placed in 88 patients; all placements were successful. Six patients died (not SEMS-related deaths) and 6 patients were lost to follow-up with SEMSs still in place. Seventy-three of the remaining 76 patients had successful SEMS removal (96.1%). The rate of successful SEMS removal per stent was 97.8% (132/135). Resolution of leaks and perforations was achieved in 59 patients (77.6%) with standard endoscopic treatment, and in 64 patients (84.2%) after prolonged, repeated endoscopic treatment. Spontaneous migration occurred in 11.1% of stents, and there were minor complications (dysphagia, hyperplasia, rupture of coating) in 20.9% and major complications (bleeding, perforation, tracheal compression) in 5.9%.
  
  
  CONCLUSIONS
  Retrospective design and highly selected patient population.
  
  
  CONCLUSIONS
  Use of SEMSs for the treatment of benign upper GI leaks and perforations is feasible, relatively safe, and effective, and SEMSs can be easily removed 1 to 3 weeks after SEPS insertion. Leaks and perforations were closed in 77.6% of cases.
authors.affiliation: Medical Surgical Department of Gastroenterology, Hepato-Pancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Swinnen
authors.forename: Pierre
authors.initials: P
authors.lastname: Eisendrath
authors.forename: Johanne
authors.initials: J
authors.lastname: Rigaux
authors.forename: Liliane
authors.initials: L
authors.lastname: Kahegeshe
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lemmers
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Moine
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D050110:Bariatric Surgery / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020878:Device Removal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004939:Esophageal Perforation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D012421:Rupture; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation