title: Endoscopic stenting for benign upper gastrointestinal strictures and leaks.
abstract: BACKGROUND
  Self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) maybe used for the treatment of benign upper gastrointestinal (GI) leaks and strictures. This study reviewed our experience with stent insertions in patients with benign upper GI conditions.
  
  
  METHODS
  Patients who underwent stent placement for benign upper GI strictures and leaks between March 2007 and April 2011 at a tertiary referral academic center were studied using an endoscopic database and electronic patient records. The technical success, complications, and clinical improvement after stent removal were compared according to type of stent. The outcomes measured were clinical response, adverse events, and predictors of stent migration.
  
  
  RESULTS
  Thirty-eight patients (50 % male, mean age = 54 years, range = 12-82) underwent 121 endoscopic procedures. Twenty patients had stents placed for strictures, and 18 had stents placed for leaks. Stent placement was technically successful in all patients. The average duration of stent placement was 54 days (range = 18-118). Clinical improvement immediately after stent placement was seen in 29 of the 38 patients (76.3 %). Immediate post-procedure adverse events occurred in 8 patients. Late adverse events were seen in 18 patients. Evidence of stent migration occurred in 16 patients and was seen in 42 of the 118 successfully placed stents (35.5 %). Migration was more frequent with fully covered SEMS (p = 0.002). After stent removal, 27 patients were evaluable for long-term success (median follow-up time of 283 days, IQR 38-762). Resolution of strictures or leaks was seen in 11 patients (40.7 %). Predictors for long-term success included increasing age and if the stent did not cross the GE junction.
  
  
  CONCLUSIONS
  Placement of SEPS and SEMS for benign refractory strictures and fistulas has modest long-term clinical efficacy and is limited by a significant migration rate. Stent migration is common and frequent with fully covered SEMS compared to other types of stents, regardless of indication or location.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA, rzs9001@med.cornell.edu.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Kim
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Amateau
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Shin
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000628:therapy*; D002648:Child; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D020878:Device Removal / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005547:Foreign Bodies / Q000209:etiology / Q000628:therapy; D005548:Foreign-Body Migration / Q000209:etiology / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010969:Plastics; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008670:Metals; D010969:Plastics