title: Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy?
abstract: BACKGROUND
  Anastomotic leaks are a life-threatening complication of gastrectomies with high mortality after surgical reintervention. Endoscopic therapy using fibrin glue injection, endoclip, and other devices is an alternative to surgical intervention for anastomotic leaks. Recently, self-expanding metal stents (SEMS) were introduced to treat anastomotic leaks. The purpose of this study was to assess the clinical characteristics and therapeutic outcomes of SEMS and nonstent endoscopic therapy (NSET) for treatment of anastomotic leaks after total gastrectomy with the aim of assisting endoscopists in choosing a treatment method.
  
  
  METHODS
  Between July 2002 and March 2013, 13 patients treated with SEMS and 14 patients treated with NSET for anastomotic leaks after total gastrectomy were enrolled onto the study. Enrolled patients received 16 SEMS placement sessions and 21 NSET sessions.
  
  
  RESULTS
  No significant differences in baseline characteristics or clinical characteristics related to leakage were detected in patients with SEMS compared to NSET. The successful sealing rate at the first attempt by SEMS was significantly better than that of NSET (80.0 vs. 28.6 %, P = 0.036), whereas the successful sealing rate after multiple endoscopic treatments was not statistically different (80.0 vs. 64.3 %, P = 0.653). The main reason for reintervention with SEMS was complications and with NSET was nonseal (P = 0.004). Clinical outcomes including length of hospital stay, endoscopic treatment-related mortality, and all-cause mortality were not significantly different between the 2 groups.
  
  
  CONCLUSIONS
  In terms of efficacy by single effort, SEMS was superior to other methods for treating anastomotic leaks after total gastrectomy. However, complications with SEMS should be considered when choosing an endoscopic treatment method.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea, kscn9@yuhs.ac.
authors.forename: Choong Nam
authors.initials: CN
authors.lastname: Shim
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
authors.forename: Mi Kyung
authors.initials: MK
authors.lastname: Song
authors.forename: Dae Ryong
authors.initials: DR
authors.lastname: Kang
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000401:mortality / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome