title: Endoscopic stent management of leaks and anastomotic strictures after foregut surgery.
abstract: BACKGROUND
  Anastomotic complications after upper gastrointestinal surgery present an arduous therapeutic challenge. Avoiding revisional surgery is desirable and might be possible with the advent of endoscopically placed stents. We reviewed our experience with endoscopic stent management of anastomotic complications after esophagogastric surgery.
  
  
  METHODS
  A prospectively maintained database at our surgical endoscopy unit was reviewed to identify patients who had undergone endoscopic stent placement after various foregut procedures. Data were obtained on patient demographics, primary surgical and endoscopic procedures, and outcome.
  
  
  RESULTS
  From January 2007 to August 2010, 18 patients (12 women, mean age 51 ± 15 yr) underwent endoscopic stent placement for anastomotic complications; 14 were bariatric patients. A total of 31 stents (21 covered metal, 5 salivary, and 5 silicone-coated polyester) were used to treat anastomotic leaks (n = 13), strictures (n = 3), and fistulas (n = 2). Symptomatic improvement occurred in all but 2 patients (89%), and early oral intake was initiated in 11 (61%). Stent treatment was successful in definitively managing the anastomotic complication in 13 (72%) of the 18 patients. Five patients required additional surgical or endoscopic intervention. Stent migration occurred in 4 cases and was amenable to endoscopic management. Two patients died, with both deaths unrelated to stent placement.
  
  
  CONCLUSIONS
  Endoscopic stent management of anastomotic complications after foregut surgery is effective in resolving symptoms, expediting enteral nutrition, and particularly successful for treating anastomotic leaks. In the absence of stents specifically designed for surgically altered gastrointestinal anatomy, some factors that might reduce the risk of stent migration include appropriate stent selection, anchoring the stent proximally, and regular surveillance after placement.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Panot
authors.initials: P
authors.lastname: Yimcharoen
authors.forename: Helen M
authors.initials: HM
authors.lastname: Heneghan
authors.forename: Nabil
authors.initials: N
authors.lastname: Tariq
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000628:therapy*; D050110:Bariatric Surgery / Q000009:adverse effects*; D003251:Constriction, Pathologic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005747:Gastric Fistula / Q000628:therapy; D006801:Humans; D007412:Intestinal Fistula / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D017792:Surgical Stapling; D016896:Treatment Outcome