title: Esophageal stents for anastomotic leaks and perforations.
abstract: OBJECTIVE
  Intrathoracic esophageal anastomotic leaks and perforations are very morbid and challenging problems. Esophageal stents are increasingly playing an integral role in the management of these patients. Our objective was to report our experience with esophageal stent placement for anastomotic leaks and perforations and to provide a treatment algorithm.
  
  
  METHODS
  We performed a review of patients with stent placement for esophagogastric anastomotic leaks or esophageal perforation from March 2005 to August 2009. A prospective database was used to collect data. Success was defined as endoscopic defect closure, negative esophagram, and resumption of oral intake. Failure was defined as no change in leak size or clinical signs of ongoing infection. We collected and analyzed patient demographics, diagnosis, clinical history, and poststent outcomes using descriptive statistics.
  
  
  RESULTS
  Thirty-seven patients underwent esophageal stent placement for anastomotic leaks (n = 22) and perforations (n = 15). The median time from original procedure to diagnosis of leak or perforation was 6 days (0-420 days). Nineteen patients (51%) had 21 associated procedures for source control. We placed 94 stents (mean = 2.7 stents/patient); 16 patients (43%) required more than 1 stenting procedure (mean = 1.8 procedures/patient). The median time to restoration of esophageal integrity was 33 days (7-120 days). There were 22 successes (59%); 2 failures were secondary to undrained abscess. Only 2 failures occurred in the last 15 patients (88% success). Strictures did not develop in any patients. Serious complications occurred in 3 patients (stent erosion, leak enlargement, fatal gastroaortic fistula).
  
  
  CONCLUSIONS
  Esophageal stents can potentially play an integral role in the management of anastomotic leaks and perforations. Success depends on appropriate procedures for source control and surgeon experience.
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn 55455, USA. jdcunha@umn.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rueth
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Groth
authors.forename: Michael A
authors.initials: MA
authors.lastname: Maddaus
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Andrade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004322:Drainage; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D018579:Patient Selection; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents