title: Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes.
abstract: BACKGROUND
  Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known.
  
  
  OBJECTIVE
  To evaluate the safety, efficacy, and outcomes of esophageal stenting in these patients and identify factors associated with successful closure.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  All patients with attempted stent placement for esophageal L/F/P between January 2003 and May 2012.
  
  
  METHODS
  Esophageal stent placement and removal.
  
  
  METHODS
  Factors predictive of therapeutic success defined as complete closure after index stent removal (primary closure) or after further endoscopic stenting (secondary closure).
  
  
  RESULTS
  Sixty-seven patients with 132 attempted stents for esophageal L/F/P were considered; 13 patients were excluded. Among the remaining 54 patients, 117 stents were placed for leaks (29 patients; 64 stents), fistulae (15 patients; 36 stents), and perforations (10 patients; 17 stents). Procedural technical success was achieved in all patients (100%). Primary closure was successful in 40 patients (74%) and secondary closure in an additional 5 (83% overall). On short-term (<3 months) follow-up, 27 patients (50%) were asymptomatic, whereas 22 (41%) had technical adverse events, including stent migration in 15 patients (28%). Factors associated with successful primary closure include a shorter time between diagnosis of esophageal L/F/P and initial stent insertion (9.03 vs 22.54 days; P = .003), and a smaller luminal opening size (P = .002).
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  Temporary stents are safe and effective in treating esophageal L/F/P. Defect opening size and time from diagnosis to stent placement appear to be candidate predictors for successful closure.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Ballard
authors.affiliation: Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kesler
authors.affiliation: Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Birdas
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Hala
authors.initials: H
authors.lastname: Fatima
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Kessler
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D004937:Esophageal Fistula / Q000601:surgery*; D004939:Esophageal Perforation / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult