title: Esophageal stent placement for the treatment of acute intrathoracic anastomotic leak after esophagectomy.
abstract: BACKGROUND
  Anastomotic leak after intrathoracic esophagogastrostomy remains a dreaded complication of esophagectomy. Traditional therapy has most often consisted of reoperative repair or observation and drainage, each prolonging hospitalization and the initiation of oral nutrition. This investigation summarizes our experiences treating these patients using an occlusive, removable esophageal stent.
  
  
  METHODS
  Over a 4-year period, patients found to have an acute, significant intrathoracic anastomotic leak after esophagectomy for benign or malignant disease undergoing surgery at or transferred to a single institution were offered endoluminal esophageal stent placement as initial therapy. Stents were placed endoscopically utilizing general anesthesia and fluoroscopy. Leak occlusion was confirmed by esophagram. Patients were followed until their stent was removed and their anastomotic leak had resolved.
  
  
  RESULTS
  Seventeen patients had an esophageal stent placed for an anastomotic leak during the study period. Leak occlusion occurred in all 17 patients. One patient was found to also have a perforation of the gastric conduit and underwent operative repair. Fourteen patients (82%) were able to initiate oral nutrition within 72 hours of stent placement. Stent migration occurred in 3 patients (18%), requiring repositioning in 2 and replacement in 1. All stents were removed at a mean of 17±9 days after placement.
  
  
  CONCLUSIONS
  Endoluminal esophageal stent placement is a safe and effective method for the treatment of an intrathoracic anastomotic leak after esophagectomy. This treatment resulted in rapid leak occlusion, provided the opportunity for earlier oral nutrition, and avoided the potential morbidity of reoperative repair or esophageal diversion.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana 46260, USA. rfreeman@corvascmds.com
authors.forename: Richard K
authors.initials: RK
authors.lastname: Freeman
authors.forename: Amy
authors.initials: A
authors.lastname: Vyverberg
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Ascioti
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome