title: Endoscopic stent insertion for anastomotic leakage following oesophagectomy.
abstract: BACKGROUND
  Intrathoracic anastomotic leakage following oesophagectomy is a crushing condition. Until recently, surgical re-exploration was the preferred way of dealing with this life threatening complication. However, mortality remained significant. We therefore adopted endoscopic  stent implantation as the primary treatment option. The aim of this study was to investigate the feasibility and results of endoscopic stent implantation as well as potential hazards and pitfalls.
  
  
  METHODS
  Between January 2004 and December 2011, 292 consecutive patients who underwent an  oesophagectomy at a single high volume centre dedicated to oesophageal surgery were included in this retrospective study. Overall, 38 cases with anastomotic leakage were identified and analysed.
  
  
  RESULTS
  A total of 22 patients received endoscopic stent implantation as primary treatment  whereas a rethoracotomy was mandatory in 15 cases. There were no significant differences in age, frequency of neoadjuvant therapy or ASA grade between cases with and without a leak. However, patients with a leak were five times more likely to have a fatal outcome (odds ratio: 5.10, 95% confidence  interval: 2.06-12.33, p<0.001). Stent migration occurred but endoscopic reintervention was feasible. In 17 patients (77%) definite closure and healing of the leak was achieved, and the stent was removed subsequently. Two patients died owing to severe sepsis despite sufficient  stent placement. Moreover, stent related aortic erosion with consecutive fatal haemorrhage occurred in three cases.
  
  
  CONCLUSIONS
  Stent implantation for intrathoracic oesophageal anastomotic leaks is feasible and compares favourably with surgical re-exploration. It is an easily available,  minimally invasive procedure that may reduce leak related mortality. However, it puts the already well-known risk of stent-related vascular erosion on the spot. Awareness of this life threatening complication is therefore mandatory.
authors: Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg Nord, Prof-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany. michael.schweigert@klinikum-nuernberg.de
authors: M
authors: M
authors: Schweigert
authors: N
authors: N
authors: Solymosi
authors: A
authors: A
authors: Dubecz
authors: R J
authors: RJ
authors: Stadlhuber
authors: H
authors: H
authors: Muschweck
authors: D
authors: D
authors: Ofner
authors: H J
authors: HJ
authors: Stein
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015607:Stents; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome